Hazardous Exposures of Prosthetic and Orthotic Workshop

Introduction

Sport injuries, road traffic accidents, diabetic condition, and accidents in work place are the common reasons for prosthetics and orthotics demand.⁸ Increased demand resulted in increased workload for the participants (which included Prosthetic & Orthotic (P&O) staff, alumni & internship students of Mobility India (MI) working in P&O workshop for minimum 5-6 hours a day). Prosthetists and orthotists report that daily work inside and outside the workshop is affecting their health. For example, professionals dealing with machinery report decrease in their hearing ability.^2,4 Exposure to high noise levels and use of chemicals can cause various types of physiological and psychological dysfunctions.^1,5

 Physiological difficulties

• Breathing difficulties

• Reduction in the perception of depth of vision

• Stomach upsets

• Effect on the ability to react and the ability to fix the memory¹

 Psychological complications

• Insomnia

• Irritability

• Reduced alertness and in severe cases, forms of depression

• Mental fatigue¹

Risk management is essential for dealing with such occupational hazards at workplaces which includes identification of hazards, assessment of risk at workplace, analysing the effects, and providing solutions to control it.⁸

Need for study

Hazardous effects related to exposure to noise pollution and chemicals at workplace have not been given much importance and finding solutions to mitigate the risk towards wellbeing of the personnel remains negligent.⁹ More so, they have been considered only as general disturbing factors which was only seen in certain areas of job.¹ Hence, it was found imperative to conduct this study to analyse the effects of exposure to noise pollution and chemicals in P&O professionals at their workplace. The study was conducted at Mobility India (MI), Bengaluru.

Methodology

Data was collected using a questionnaire from a reliable published source regarding physical and psychological complications, social performance and stress experienced. This was followed by collection of feedback individually from each participant. Decibel meter application was used to measure sound levels in the workshop. Chemical exposures in workshop were identified and analysed. 

Study Design

Cross-sectional study (sample size = 50 P&O professionals including staff, alumni and internship students)

Inclusion Criteria

 Prosthetic & Orthotic (P&O) staff, alumni & internship students of Mobility India (MI) working in P&O workshop for a minimum of 5-6 hours per day, exposed to hazards on a regular basis.

 Articles including various research studies conducted about hazards in workplace and side effects of its long-term exposure and also articles including strategies to measure noise.

Exclusion Criteria

 Staff & students of Mobility India (MI) involved in workshop for <5 hours per day on a regular basis.

Research Study Description

Preliminary data was gathered using a verified questionnaire along with overall participant feedback. The survey to collect the data was conducted by interviewing the participants at their workplace and also through telephonic interviews. The participants included staff, alumni and internee students of Mobility India (MI) having more than five hours exposure per day in P&O workshop.

The measurement strategy was designed, and then measurements were conducted. The strategy was developed based on the machines commonly used, operator positions for the machines, information on number of employees and their respective duties & tasks, and also the hours of noise and chemical exposure.

The project strategy was planned in a three–way manner which included - first identifying the major areas of hazardous exposures (noise and chemical) in the workshop.

Secondly, measuring the decibels of sound produced by each machine individually and measuring the decibels of sound when all the machines were operated together. This was followed by the third strategy of measuring the sound produced by other equipment and tools in the workshop. All measurements of sound in decibels were done using the decibel meter application and it was reset after each measurement.

Functional outcome and evaluation tool

 Recordable verified questionnaire

 Decibel meter

Results

The frequency of noise produced by the machines and tools during working hours was measured. Psychological and physiological problems due to noise exposure were analysed and results of the questionnaire survey were represented in the form of a bar graphs and tables.

The sound produced from machinery in the workshop was more than 85 DB power and this number is higher than the normal hearing range, which is about 60 DB.8 Hence, the noise produced in workshop can be considered as a root cause for hearing loss and this noise pollution can be an occupational noise hazard which causes many physiological and psychological effects as depicted in the bar graph6 (Figure 2). The rising percentages indicate an immediate need for attention.⁴

One of the issues identified during the study was the lack of awareness about noise pollution among the participants and about safety norms & procedures regarding hearing protection and any devices to prevent the hazards of noise. Hundred percent of the participants (50 P&O professionals) were unaware of the levels of noise exposure in workshop and its levels of risk, while 94% were not using any sort of earplugs and only 6% of the sample was using other kinds of hearing protection (Figure 3). Main reasons for not using ear protectors / ear plugs could be the lack of awareness of major health hazards caused due to noise exposure, lack of strict inspection and uncomfortable feeling and pain while using the ear plugs provided to them.

Among the fabrication procedures, the maximum risk factors were activities such as mixing POP powder in water in casting process, breaking positive cast after socket fabrication, applying POP bandage during casting, removal of negative cast after casting process, opening socket with PP cutter, cutting socket with jigsaw, using dendrite on soft foam, using suction machine, and modification of positive mould. All these were high risk activities involving various health hazards.⁸

Discussion

An analysis was done based on the questionnaire responses and personal interviews regarding health conditions and by identifying area of chemical exposure during activities along with measuring sound levels for proper depiction of health hazards caused in P & O workshop. The reference of the articles on hazards due these exposures provided a clear-cut idea on how to identify and limit these exposures.¹

These hazards expose prosthetist /orthotist to many health-related issues and problems at workplace.¹⁰ A management principle for the risk caused must be applied to minimize various hazardous exposures of P&O professionals, which will in turn lead to increased safety in work environment. Identification of various hazardous conditions and proper assessments are the initial procedures in managing the risk and in the fabrication of devices.⁸

From the organizational point of view, it is necessary to avoid simultaneous use of equipment and machinery, therein, making more frequent shifts of participants to lower the exposure period, and finally giving the participants the necessary devices and personal protective equipment to reduce the sound vibrations.3 From the structural point of view, it is necessary to install sound-absorbing panels along the side walls in sheets to absorb the sound waves generated by the machinery. In addition, because the replacement of machines is impossible, it is important to improve the efficiency of sound through frequent maintenance operations and with the usage of technology to decrease friction of the moving parts, noise reduction can be achieved.⁴

Conclusion

Occupational hazardous exposure in P&O workshop was quite obvious, and high levels of noise pollution was observed.

The information gathered in this study can be used for a variety of purposes such as establishing high noise and chemical exposure areas, identifying individual noise sources and their character, identifying the areas/ machines resulting in exposure of participants, creating a plan in order to decide what to measure and how to measure and for how long, to analyse the nature of the tasks carried out by participants, to know about  the participant’s environment, which also depends on the activities of neighbouring participants and also to identify the type of exposure.⁷

In conclusion, in the present study, the values of noise measured, and chemical hazards identified were found to be substantially above the regulatory limits. The operating conditions generating them were repetitive with continuity over the entire work shift. This significantly increased the time period of exposure and thereby greatly increased the risk towards well-being of the personnel working in a P&O workshop.

Recommendations

Potentially harmful processes and/or operations should be carried out by well-maintained equipment / machines. Wherever possible, separate areas should be designated for such processes and operations.

The personnel engaged particularly in grinding or polishing operations must wear suitable protective gear such as protective eye wear, ear plugs, masks, hand gloves, protective aprons etc. Management ought to pay highest possible attention towards procurement of such protective gear and their usage by the P&O personnel in the workshop.

• Standard Operating Procedure must be prepared and periodic training should be given to P&O personnel to make them aware of occupational hazards and safety measures.

• All workshop equipment should be kept in good condition, with a periodic maintenance schedule.

• Management should formulate Standard Operating Procedure as a guideline towards occupational safety and should adhere to periodic inspection and reporting.

Staff must be instructed to take the allotted paid holidays on compulsory basis to enhance their efficiency while working.¹¹

Conflict of interest

None