RESPIRATORY PROTECTION PROJECT IN SOMNOMED PHILIPPINES, INC.

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1 RESPIRATORY PROTECTION PROJECT IN SOMNOMED PHILIPPINES RESPIRATORY PROTECTION PROJECT IN SOMNOMED PHILIPPINES, INC. Rubayat Indradi College of Medicine, University of Muhammadiyah jl. Bendungan Sutami 88A Malang indradi.baladewa@gmail.com ABSTRACT Background: SomnoMed Philippines is classified as a manufacturing type of company that creates effective and comfortable dental devices like SomnoDent, SomnoBrux and SomnoSnore to treat snoring, bruxism and obstructive sleep apnea (OSA), respectively. Dusts from this products can affect workers as manifested by respiratory symptoms such as cough and colds. The goal was to contribute to the improved general health of workers of through effective enforcement of strategies to ensure good environmental air quality. The purpose was to reduce the exposure of workers to respirable dust to standard (ACGIH mg/m ) in SomnoMed Methods: To assess the workplace, a walkthrough survey, review of related documents and key informant interviews were made. Hazards were identified and analyzed using a set of criteria such as magnitude of the problem, feasibility and impact of the program. Results: The outputs made during the three weeks of implementation include the following: () developed Occupational Health and Safety (OHS) policy, () established OHS committee, () assessed air quality and () improved knowledge of workers. Conclusions: Accomplishments include creation of OHS policy, creation of OHS committee, respirable dust analysis in the workplace, distribution of information, education, and communication materials, and provision of lectures. Keywords: workplace, Occupational Health and Safety (OHS), dust, air quality INTRODUCTION Established in 00, SomnoMed Philippines is classified as a manufacturing type of company that creates effective and comfortable dental devices like SomnoDent, SmonoBrux and SomnoSnore to treat snoring, bruxism and obstructive sleep apnea (OSA), respectively. It is a subsidiary of SomnoMed Ltd. which based in Sydney, Australia (SomnoMed Philippines, 00). SomnoMed relies on an extensive integrated inter-disciplinary team to achieve exceptional levels of treatment acceptance, compliance and efficacy. The team is comprised of professionals from a number of related fields including sleep specialists, general practitioners and other medical specialists, dentists and sleep laboratory technicians (SomnoMed Philippines 00). The company manufactures the dental devices such as SomnoDent, SomnoBrux and SomnoSnore. SomnoDent devices have types namely: () SomnoDent Flex, () SomnoDent Classic, () SomnoDent Edent and () SomnoDent G. SomnoBrux devices consist of types: () SomnoBrux Michigan, () SomnoBrux Tanner and () SomnoBrux Gleb (see Figure -).

2 VOLUME NOMOR JUNI 0 Figure. Classification of SomnoMed Products. Figure. Types of SomnoMed Products.,,

3 RESPIRATORY PROTECTION PROJECT IN SOMNOMED PHILIPPINES Process Flow in Manufacturing of SomnoMed Products. Specific steps are as follow in the creation of SomnoMed Products: To create SomnoDent Flex, raw materials are initially received and inspected for quality of dental impression. This is then surveyed/blockedout, duplicated, thermoformed, invested, articulated, sprayed up (upper device), placed with screws, sprayed up again (lower device) and goes to finishing. The SomnoDent G shares similar process with SomnoDent Flex from receiving, inspecting of work orders, sur veying/ blocking-out, duplicating, thermoforming with thermofoil, investing, BFlex processing and articulating. The difference is that spray-up of upper device is followed by spray-up of lower device. The coupling mechanism is then designed and mounted before it undergoes finishing. In the production of SomnoDent Classic, after the dental impression and other raw materials are received and inspected, the dental impression is duplicated right away, then articulated and surveyed/ blocked-out. Ball retainer clasps are then installed. This is followed by sprayup upper, screw placement, spray-up lower and finishing (see Figure.). Figure.. Process Flow of SomnoDent Flex, SomnoDent G and SomnoDent Classic, SomnoMed Philippines, Inc.

4 VOLUME NOMOR JUNI 0 In the manufacturing process of SomnoSnore, the dental impressions and other raw materials are initially received. Dental impression are inspected, surveyed/ blocked-out and duplicated. It undergoes thermoforming but with a thicker thermofoil as compared with other SomnoMed products. The resulting product are then articulated, attached with lug and then undergoes spray-up before finishing. In SomnoBrux, raw materials are initially received, then the dental impressions are inspected. This is then surveyed/ blocked-out, duplicated, thermoformed, invested/ undergoes BFlex processing, articulated, sprayedup and then removes excess hardened Orthocryl by grinding and trimming. Afterwards, finishing follows (see Figure.). Figure.. Process Flow of SomnoSnore and SomnoBrux, SomnoMed Philippines, Inc.,, The company currently employs ninetyeight employees. It is therefore classified as Type D (less than 00 employees) according to the Philippine Occupational Health and Safety Standards (005). Eighty-four workers (86%) are assigned in the production area and fourteen workers (%) works in the administrative and maintenance area. Age range is between 8-5 years old. The male-to-female ratio is at :0, consisting of 56% males and % females (see Figure ). Figure. Percentage of Male and Female Employees in SomnoMed Philippines, Inc. 0.

5 RESPIRATORY PROTECTION PROJECT IN SOMNOMED PHILIPPINES 5 Three shifts are followed in the production area in the company. The first shift starts at 5:0AM- :00PM, the second shift is at 8:00AM-:0PM and the last shift is at :00PM- 0:0PM. At present, there are (5%) workers working in the first shift, (%) workers in the second shift and (8%) workers in the third shift in the production area (see Figure 5). Shifting schedules change every two weeks. M eanwhile, the administrative office starts at 8:00 AM and ends at 5:00 PM. Figure 5. Percentage of Employees per Shift in the Production in SomnoMed Philippines, Inc., 0. For each shift, workers have two snack breaks that last 5 minutes for each break and lunch break that lasts 0 minutes. For the first shift, there are two snack breaks in the morning at :00-:5AM and 9:00-9:5 AM and lunch break at 0:0-:00 AM. For the second shift, snack breaks are done at 0:00-0:5 AM and lunch break at :00-:0 PM. For the third shift, snack breaks are at :00-:5 PM and 6:00-6:5 PM and lunch break at :00-:0 PM. Health and Safety Programs The Occupational Health and Safety (OSH) Committee was not present yet, at the time of initial visit. Even in the absence of OHS Committee, the company has a personal protective equipment (PPE) program to which PPE such as latex gloves, heat-resistant gloves, procedure mask and apron are supplied to their workers. Preemployment and annual physical examination (APE) are also conducted to their employees. Membership in the health maintenance organization (HMO) provider is also an advantage to supply for the medical needs of workers. Fire protection is also part of their programs. This includes provision of fire alarm systems, evacuation route and fire extinguishers in strategic areas. Currently, the company do not have a nurse. A first aider, who is also an employee, only when present in a certain shift handles emergency cases. Philippine Occupational Health and Safety Standards (005) states that in a Type D company, there should be one part-time nurse who should work four hours per day, for six times per week in the company. 5 Where there are more than one work shift in a day, like SomnoMed Philippines, Inc., the nurse should stay in the workplace during the shift which has the biggest number of wonders. The employer should also provide the services of a full-time first-aider and should maintain in his/ her place of employment an emergency treatment room for his workers. METHODS To assess the workplace, a walkthrough survey, review of related documents and key informant interviews were made. Hazards were identified and analyzed using a set of criteria such as magnitude of the problem, feasibility and impact of the program. The exposure to respirable dust came out to be the top priority. To analyze and prioritize the problems, criteria were set. Criteria is based on magnitude of the problem, feasibility to solution and impact of the program.

6 6 VOLUME NOMOR JUNI 0 Table. Problem Prioritization Scores, SomnoMed Philippines, Inc., 0. Type of Hazard Magnitude of the Problem Feasibility to Solution Heat % Score % 85 Score % 6 Score 0 Noise Vibration Chemical Respirable dust Biological Ergonomic Cockroach Physical ergonomic concerns Cognitive ergonomic concerns Hazardous tools and materials Poor housekeeping Absence of PPE Inappropriate PPE Electrical hazard Fire hazard Absence of machine guard Absence of emergency wash areas Absence of Occupational Health and Safety Committee Absence of part-time nurse Failure of use Use of PPE inappropriately Failure to follow SOP Physical Unsafe Conditions Unsafe Acts Hazard A review on the Material Safety Data Sheet (MSDS) in SomnoMed showed that specific chemicals are currently used during production.,8 Dusts from this products can affect workers as manifested by respiratory symptoms such as cough and colds. For this reason, it is important that a respiratory protection project should be implemented in the company. Impact of the Program Total Score RESULTS. Enhancing the occupational health and safety (OHS) of SomnoMed by policy development in week.. Promoting occupational health and safety (OHS) of the SomnoMed by development of OHS committee in week

7 RESPIRATORY PROTECTION PROJECT IN SOMNOMED PHILIPPINES. Assesment air quality by respirable dust concentration analysis at the beginning and end of the project.. Improvement of the worker s knowledge about the causes, effects, management and preventive measures on exposure to respirable dusts as indicated by a significant increase of knowledge from baseline on paired t-test in weeks. DISCUSSION Creation of Occupational Health and Safety Policy. Initially, a needs assessment was made as to the occupational health and safety policy statement. A meeting was held to determine what specific areas the policy needed to be in place. An initial draft was then made based on the outputs of needs assessment. It was then submitted for approval by the management. The approved policy was distributed by posting two posters of the OHS policy statement in strategic areas of the workplace. Upon presentation of final report to the OH Committee, it was suggested that a more concise poster should be made; hence the creation of such. In line with the OHS policy of the company, two other specific policies were made; namely, the creation of OHS committee and the policy on respiratory protection. The schedule by which the activities should have been accomplished on the first week of implementation was not followed. Of note, the approval and dissemination of the policy was made on the third week. Though the management was very supportive of the activity, it was a challenge to the group to gather the team from management during that time because of their hectic schedule. Despite the delay of completion, the activity was still carried out smoothly before disengagement as reminders were given from time to time. Creation of Occupational Health and Safety Committee. Upon approval of the OHS policy statement and policy on creation of OHS committee, officers in the committee were appointed. This was comprised of seven officers; namely, the chair, secretary and five members. A preliminary meeting was made with most of the officers such as the secretary and members were present. The chair during that time was on hospital leave and the full-time first aider who was a member of the committee ended her shift already. Assessment of Respirable Dust. Assessment of the air quality by respirable dust analysis was made in 6 strategic areas of the workplace which include the meeting room, administrative office, training area, pantry and production areas consisting of stage and stage areas. Before air sampling was done, the filters used were dessicated for hours. After which, the sampling pumps were calibrated and placed on strategic areas. Air sampling was done within four hours. On such time, the production was on its peak. After sampling, the filters were once again dessicated for hours and weighed. Pre and post sampling filter weights, including that of the control were compared as part of the analysis of results. The concentration of the respirable dust was then computed. The highest concentration was obtained in stage II (0.8 mg/m ). This was followed by stage I (0. mg/m ), pantry (0. mg/m ), training area (0. mg/m ), administrative office (0.9 mg/m ) and meeting room (0. mg/m ). Results was lower than the threshold limit value- total weighted average (TLV-TWA) which was mg/m hence the results obtained were still within the standards. Looking on the Logical Framework Approach (LFA), the purpose of the project was to reduce the exposure of workers to respirable dust to standard (ACGIH mg/m ) in SomnoMed in 6 months. 9 Since baseline respirable dust measurements done showed levels within the standard already, the purpose can be changed to maintain such levels. When the project is carried out, not only will it help maintain respirable dust levels within the standard but it will also decrease the exposure of workers to inhalable dusts that can lodge in the upper airway. It will also address problems of exposure to other airborne chemicals such as vapors and fumes which might also be present in the workplace. Information Dissemination. For information dissemination, posters and brochures were developed after pre-testing with the general administrator, production super visor and production worker. Five copies of posters and one hundred copies of brochures were posted and distributed respectively. Lecture consisted of topic on dust. Specifically, the parts of airway, definition of dust, types of dust, examples of dust, process of dust generation, signs and

8 8 VOLUME NOMOR JUNI 0 symptoms of dust exposures, effects of dust, first aid for acute dust exposure and preventive control measures on exposure to dust was discussed. The lecture consisted of three batches to accommodate workers from the production area and members of management. Attendance was obtained for each batch. Examinations were given as pre-test and post-test to determine if there was significant increase in knowledge of attendees from baseline. Analysis of results using paired T-test showed significant increase in the knowledge on each batch and the entire batch as a whole. CONCLUSIONS Accomplishments include creation of OHS policy, creation of OHS committee, respirable dust analysis in the workplace, and distribution of information, education and communication materials. This project included the following activities: review of goal, purpose, component objectives and activities; and report on accomplishments, recommendations and immediate endorsement. Materials used during the project was also turned-over. This include policies, posters and brochures. The Philippine Occupational Health and Safety Manual, posters and brochures from Philippine Occupational Health and Safety Center were also endorsed. Monitoring checklist, minimum medical supplies needed and a list of suggested personal protective equipment were also endorsed. It is also recommended that the OHS policy statement can be incorporated along with mission and vision of the company. Other forms of chemicals such as vapors and fumes can be analyzed after desk LEV s are reinstalled. The total dust can also be monitored to have a rough estimate of inhalable dusts especially dusts with bigger diameter which can also affect the upper airway of workers. Material Safety Data Sheets, The Mystery of Lyle and Louise Footprint Analysis. (n.d) retrieved April, 0 from: ww w.crosscutt ingconcep ts.co m/llmodules?format=raw&task=download&fid=0. SomnoMed Philippines (00). Company Production Manual. SomnoMed (008). SomnoDent. Retrieved April 5, 0. f r o m : h t t p : / / w w w. s o m n o m e d. c o m. a u / Patients_and_Families/Sleep_Apnea_/ SomnoDent.aspx. SomnoMed (008). SomnoSnore. Retrieved April 5, 0 from: h t t p : / / w w w. s o m n o m e d. c o m. a u / P a t i e n t s _ a n d _ F a m i l i e s / S n o r i n g / SomnoSnore.aspx. SomnoMed (008). SomnoBrux. Retrieved April 5, 0 from: h t t p : / / w w w. s o m n o m e d. c o m. a u / Patients_and_Families/Teeth_Grinding/ SomnoBrux.aspx. United States Department of Labor. (n.d.). Particulates not otherwise regulated, respirable. Occupational Safety and Health Administration. Retrieved April, 0 from: /pdfs/0600.pdf. World Health Organization. (00). Logical Framework Approach Guidelines. Retrieved April 0 from: ncd/vision00_actionplan/documents/ LFAguidelines.pdf. REFERENCES Guidelines on Personal Facilities for Workers Required Under Chapter VII Industrial Hygiene of the Sanitation Code of the Philippines.(n.d). Retrieved April, 0 from: GuidelinesonPersonalFacilitiesforWorkers.pdf.

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