Health and safety management forms part of the overall risk management of medical institutions, and deals with the responsibility of an organisation to provide a risk free environment for all who are exposed to the activities of such medical institutions. Affected people include health care workers, contractors, visitors, and patients. Medical institutions, and hospitals specifically, are uniquely distinct from other industries in that they employ highly skilled staff with specific specialised knowledge. These institutions are also increasingly making use of complex technology that requires specialist staff to operate medical machines and equipment. These specific aspects are accounted for in this research. The overall purpose of this research is to determine the need for an alternative approach to the management of health and safety in medical institutions. An appropriate model will be developed that can be integrated into the existing health and safety management system. The research methodology for this study comprises the following steps: Firstly, the health and safety environment was researched in relation to all stakeholders, external and internal, that are affected by medical institutions’ activities. The effect of these activities, and how it influences health and safety management, was evaluated in a South African context. Secondly, the overall risk management approach of medical institutions and the effect of organisational culture were researched to determine the effect on health and safety performance. Thirdly, a questionnaire was sent to selected staff of five hospitals in the Eastern and Western Cape to determine their perception and experience of health and safety management. Quantitative data on incidents in Netcare Hospitals were obtained, and a comparison of the questionnaire studies was done to determine the need for a health and safety model. The final step of this study entailed the development of a health and safety model using legislative requirements and the needs identified in the research. A proposal is made to integrate specialist functions and departments into the existing health and safety management system, in order to strengthen the managerial capabilities of such a system. The importance of improving the safety and compliance culture is indicated.

This is a qualitative study that seeks to explore the workers’ perceptions towards the occupational safety and health administration (OSHA) system at the petrochemical industrial plant Sasol Infrachem in Sasolburg. It provides a platform for shop floor workers to express their subjective perceptions of the company’s OSHA measures by answering open ended questions. The study advances the notion that notwithstanding the safety managers’ efforts towards ensuring a safety regime in the workplace, however lucrative these might be, to really ensure a safe working environment in the workplace will always depend on the individual workers’ motivation to participate safely at work at any given time to ensure his/her safety and that of others. The study explores this subject by considering how they perceive these safety strategies, their vigilance, attitudes, their ownership of these and their inclination to comply with the occupational safety and health administration measures of Sasol. This study follows a Postmodernist theoretical framework emphasizing differences. Difference is a first and foremost identity feature of human beings. This goes for both their external and internal qualities. How workers perceive and relate to safety concepts will always be shaped by the differences among them. The study also makes use of the Environmental Justice Theory as a central theme, that holds that one life lost is one too many. At the forefront of industries are shop floor workers who are most vulnerable to workplace incident.The study assumes this premise with regard to their safety and health in the workplace

Aunque la empresa cuenta con un Sistema de Seguridad y Salud Ocupacional formulado por la Supervisora de Seguridad y Salud, este no es adecuado y resulta poco útil debido a que no cumple con algunos aspectos importantes de las leyes N° 29783: Ley de Seguridad y Salud en el Trabajo y N° 30222 (ley que modifica la ley 29783); así como los decretos supremos N° 005 2012 TR y N° 006 2014 TR. Por consiguiente, esta investigación permitirá a la empresa mejorar su Sistema de Seguridad y Salud Ocupacional. Esto traería beneficios sustanciales para Plásticos Joly: un mejor clima laboral, incremento de su valor en el mercado y una reducción de costos ocultos al cumplir con la legislación vigente. / Trabajo de investigación

Tecandina S.A., es una empresa peruana que desarrolla trabajos de Consultoría ambiental en el subsector minería, cuenta con 12 trabajadores en oficina y contrata por proyectos a profesionales especializados en temas minero–ambiental. Las labores administrativas son realizadas en las oficinas ubicadas en la ciudad de Lima mientras que trabajo de campo necesario para la recopilación de información, es realizado en las zonas donde se desarrollan los proyectos mineros ubicados, en su gran mayoría, en la sierra del Perú. El principal objetivo del presente trabajo es diseñar un Sistema de Gestión de Seguridad y Salud en el Trabajo (SGSST), que le permita a Tecandina S.A. llevar a cabo la implementación, verificación y control del mismo, para conseguir este objetivo, se realizó un análisis del entorno externo e interno de la empresa, el diagnóstico (línea base) de la situación actual en la que se encuentra la empresa relacionada a la seguridad y salud en el trabajo, finalmente se calculó el costo que involucra implementar y mantener el SGSST. / Tecandina S.A. is a Peruvian company that develops environmental consultant work in the mining subsector; has 12 workers in its office and hires professionals specialized in mining and environmental issues for their projects. Administrative labors are done in Lima, while the necessary fieldwork to gather information is performed in areas where mining projects are located, mostly in the highlands of Peru. The main objective of this research is to design a Work Safety and Health Management System (OHSMS), that allows Tecandina S.A. to carry out its implementation, verification and control; to achieve this goal , an analysis of the external and internal environment of the company was performed; the company´s current situation diagnose (baseline) related with safety and health at work; and finally the cost involved in implementing and maintaining OHSMS was calculated. / Trabajo de investigación

El presente trabajo de investigación plantea la implementación de un Sistema de Gestión de Seguridad y Salud en el Trabajo (SGSST) a partir de la adecuación a los requisitos legales vigentes de la Ley N° 29783: Ley de Seguridad y Salud en el trabajo (SST)1 y sus modificatorias; desarrollándose en SUMIT S.A.C., empresa dedicada a brindarel servicio de confección y exportación de prendas de vestir ubicada en el distrito de Ate, Lima – Perú, debido a que la empresa ha decidido implementar un SGSST que le permita adecuarse a los requerimientos de la Ley mencionada. / This research proposes the implementation of an Occupational Safety and Health Management System (OSH-MS) from the adjustment of the current legal requirements from Law N° 29783: Occupational Safety and Health peruvian law and its modifications; developed in SUMIT S.A.C., a company dedicated to providing the service of manufacturing and garments exportation, located the district of Ate, Lima – Peru, because the company has decided to implement an OHSMS that allows suit the requirements of the aforementioned law. / Trabajo de investigación

In the early decades of British industrialization, the ill-health of textile factory workers attracted considerable public interest and provoked discussion and debate among a growing number of medical men, operatives, manufacturers, and social and political commentators. Guided by previous studies of the “framing” of disease, this dissertation examines how such ill-health was conceived, designated and responded to in the period from 1784 to 1833. The dissertation reveals that workers themselves held a relatively constant view of their condition. In the early part of the nineteenth century, they drew attention to a variety of ailments and throughout the period they saw a clear link between their maladies and the conditions of their labour. By contrast, medical understanding shifted significantly, and as it traced a course more or less at odds with that of popular comprehension, the nature and causes of worker suffering were substantially redefined. In the 1780s and 1790s, doctors identified the illness of factory labourers as “low, nervous fever,” an acute contagious disorder generated by the crowding and confinement of human bodies. A generation later, in the period from 1815 to 1819, the ill-health of mill workers was conceptualized, by a portion of the medical community, as “debility,” a poorly-understood state of constitutional feebleness attributed to aspects of machine work. In the early 1830s, medical authorities regarded factory workers’ sickness primarily as “digestive disease” and located its source in habits and diet. The reconceptualization of worker ill-health yielded an ultimately optimistic assessment of the consequences of industrial growth, failing to offer strong support to demands for legislative restriction of factory operation. It also served to sanction changing social relations through providing evidence of the physical and moral distinctness of the manufacturing population. As medical theory altered, so, too, did practices of relief and assistance. While mill owners, and doctors, became increasingly unwilling to assume responsibility for the well-being of the industrial workforce, operatives engaged ever more extensively in practices of self-help. The expansion of the textile industry, however, ensured the continuation of their affliction and incapacity. / Arts, Faculty of / History, Department of / Graduate

Coronary heart disease takes a large toll of middle-aged males thereby reducing the overall occupational fitness and potential of the workforce. Most of the risk factors for CHD (and other diseases) are self-determined and/or the result of preventable behaviour or alterable environment. The Multiple Risk Factor Hypothesis and the CHD risk factors are reviewed in detail in Chapter 2. It is more the interaction among risk factors within supposedly "normal" limits, rather than abnormally high levels of one or a few factors which results in the development of CHD, a phenomenon which obscures the issue of causation. It is hypothesized that the imbalance between the collective pathogenic effects of risk factors and the ability of the body to resist and/or repair such effects cause CHD. States such as sedentariness and obesity in which most of the risk factors tend to be clustered are important risk indicators. Moreover, since the overall risk profile is improved with reversal of these two states through regular aerobic activity and weight loss, the latter two are key interventions in CHD prevention. Risk factor screening to identify those at risk and subsequent modification of the risk status are useful manoeuvers for the prevention of CHD. As well as being secondary to the ravages of such diseases as CHD, occupational productivity is also reduced by poor levels of employee physical fitness. The recognition by employers of the potential success of CHD prevention programs and the increased productivity of the fit employee has led to the emergence of employer-sponsored occupational fitness programs. Such programs are based on a wholistic health-enhancement approach with regular aerobic physical activity as the core. The operative principles, contents (including the what and how of the all important assessment component) and benefits of such programs are reviewed in Chapter 3. A review of the state of health and fitness in the Canadian Forces and the experimental portion of the thesis make up Chapter 4. In spite of policies, orders and programs to ensure the health and fitness of Canadian Forces' personnel, the CF remains a fairly high-risk population. The cross-sectional study on the health and fitness of 2 83 CF personnel at National Defence Headquarters shows that Other Ranks constitute a higher-risk rank grouping than Officers, as do lower ranks in both of these two major rank groupings. Volunteers appear to be a self-selected sub-population which is healthier and fitter than average. Aerobic fitness (VO₂ max), obesity and resting heart rate emerge as the three key indicators of health and CHD risk status. Chapter 5 summarizes the thesis and contains conclusions and recommendations to the CF for future actions which are also applicable to most occupational settings. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Methicillin-resistant Staphylococcus aureus (MRSA) was originally recognized as a hospital acquired infection. However, it is now recognized that MRSA infections are frequently acquired in the community setting as well. As epidemiological studies and surveillance of MRSA continued over the past decade, agricultural sources of MRSA have also been recognized. Although direct person-to-person transmission of MRSA has been recognized as a major known route of transmission, a preliminary study has shown that aerosol exposures may also be an important mechanism of transmission, both occupationally to workers inside animal feeding operations and environmentally via exhaust ventilation to the outside e. In this study I aimed to 1) determine the concentration of viable MRSA inside and outside swine buildings known to be positive for MRSA, 2) determine the efficiency of the N95 respirator at protecting workers inside swine buildings, and 3) determine the efficiency of a biofilter unit at mitigating emissions of MRSA from a swine building. I hypothesize that remediation and control of airborne MRSA in animal feeding operations can be achieved by the appropriate use of N-95 respirators to protect workers and the addition of biofilters to the exhaust ventilation system to mitigate transmission of this emerging environmental contaminant to the outdoor environment. The results of the study indicate that MRSA in the respirable size range can be detected inside a swine building and 215 m downwind of the swine building. Aim 2 results indicated that the N95 respirator was efficient at protecting workers exposed to MRSA particles greater than 5 μm but not as effective with MRSA particles less than 5 μm. The results of aim 3 indicated that hardwood chips and western red cedar chips are efficient biofilter media for mitigating the emission of MRSA from a swine building. These studies showed that workers inside swine buildings and the outdoor environment can be protected against the transmission of MRSA with a respiratory program which includes the use of N95 respirators and biofilters as mitigation control measures.

Three main research products are reported in this dissertation. This research focused on estimation of the seroprevalence rates in agricultural workers with exposure to pigs and poultry, and determination of risk factors for infection. Chapter 2, "Are swine workers in the United States at increased risk of infection with zoonotic influenza virus?", reports controlled, cross-sectional seroprevalence studies among farmers, meat processing workers, veterinarians, and control subjects. Using a hemagglutination inhibition assay against six influenza A virus isolates, all 3 exposed study groups demonstrated markedly elevated titers against the H1N1 and H1N2 swine influenza virus isolates, compared with control subjects. Chapter 3, "Infection due to 3 avian influenza subtypes in United States veterinarians", describes a controlled, cross-sectional seroprevalence study that examined veterinarians in the United States for evidence of previous avian influenza virus infection. Using a microneutralization assay against 9 influenza A virus strains, veterinarians exposed to birds demonstrated statistically significant elevated titers against the H5, H6, and H7 avian influenza virus isolates compared with control subjects. In chapter 4, "Cases of swine influenza in humans: a review of the literature", all known human cases of swine influenza are compiled and analyzed. Fifty cases of apparent zoonotic swine influenza virus infection, including 37 civilians and 13 military personnel, were identified, with a case-fatality rate of 14% (7 of 50 persons). Most civilian subjects (61%) reported exposure to swine. These studies provide strong evidence that transmission of zoonotic influenza likely occurs much more frequently than previously thought, and that individuals with occupational exposure to pigs and birds are at elevated risk for acquiring zoonotic influenza infections. Agricultural workers should be included in pandemic influenza planning, should receive information and training on how to use personal protective equipment, and should be offered human influenza vaccine to reduce the risk of creating viral reassortants. In the event of a pandemic, workers should be considered for antiviral medications and pandemic strain vaccines.

The long-term goal of this research is to reduce the number of deaths by suicide. Suicide is the leading cause of violent death in the United States, and is currently the 10th most common cause of death across all age groups. Suicide prevention efforts have historically been focused on youth/young adults, and the elderly, with less attention on programming for individuals in the working years. Our intention is to generally broaden the understanding of suicide, depression and the workplace, with the hope of improving interventions for this underserved population. The research activities outlined below were conducted under the auspices of a larger quasi-experiment at the University of Iowa. We first sought to assess the experiences of professional, nonclinical staff identifying and responding to apparently mental health problems in the workplace. We looked at the impact of two exposures on engagement with individuals in crisis: self-reported contact (the number of students or coworkers a participant interacted with each week), and participation in any suicide prevention training/programming over the previous five years. High contact with students was generally associated with a greater capacity for recognizing and responding to depression and potential suicidality. In contrast, the association between high contact with employees and recognition and response was insignificant for four of the six recognition and response behaviors. Participation in any form of suicide prevention training or programming in the previous five years was highly associated with recognizing and responding to depressed or suicidal coworkers and students. Next, we considered the impact of a personal prior experience with suicide and prior suicide prevention training/programming on four constructs: preparedness to respond to someone in crisis, familiarity with appropriate resources, gatekeeper self-efficacy, and gatekeeper reluctance. Suicide prevention training/programming was significantly associated with higher perception of three constructs: preparedness, familiarity, and self-efficacy. There was no statistical difference in reluctance between previously training participants and participants who had not previously taken suicide prevention training or programming. Individuals who had a personal prior experience with suicide were less reluctant to engage, although the results were not significant. There was an association between individuals who had a personal prior experience with suicide and suicide prevention training/programming, suggesting that individuals with a personal connection to suicide might be more likely to enroll in suicide prevention programming. Finally, we examined how a suicide prevention training programming impacted the perception of safety culture in the workplace. On the 10 item safety scale, there was a significant difference between the means scores reported by the intervention and control group on 7 of the 10 questions. Individuals who participated in QPR gatekeeper training reported a higher sum safety culture score than individuals who did not participate in the training; the overall model was statistically significant. This project shows that suicide prevention training/programming of any kind in the workplace can have a persistent, positive training impact on employees by informing and empowering them to act. It suggests that individuals with a personal prior experience with suicide may be more likely to take suicide prevention training, and may be less reluctant to engage with someone in crisis. It also demonstrates that suicide prevention training may have a positive impact on other workplace psychosocial factors, and deserves prioritization in workplace wellness programming.