1 An ICT application for real time surveillance and prompt discovery of emerging new occupational health hazards Pierluigi Cocco Cesare Cappio Borlino Carlo Manca Giorgio Marracini Department of Public Health, Occupational Health Section, UNIVERSITY OF CAGLIARI. METSO, Srl INAIL, Regional Office of Sardinia, Cagliari OSH Department, LOCAL HEALTH UNIT N. 8, Cagliari
2 Occupational Health and Safety (OSH) in Italy occupational medicine professionals provide health surveillance and exposure control at the workplace OSH departments of the Local Health Unit provide workplace inspections, enforce control of OSH procedures National Institute for the Insurance against workplace injuries and occupational diseases (INAIL) with the support of Occupational Health clinics provides diagnosis of occupational diseases INAIL receives claims and provides compensations for workplace injuries and occupational diseases INAIL-ISPESL research and guidelines
3 Occupational Health and Safety (OSH) in Italy Critical issues The spatial coverage of the local units of the various agencies is driven by specific scopes, and tradition, not general interests, and it does not overlap with each other. Each agency has its own data management system. Communication between agencies is delayed and difficult.
4 Examples of existing data bases of occupational diseases and workplace injuries in Europe Belgium; France; Germany; Ireland; Italy; Norway; United Kingdom. Aims: to study the etiology and circumstances of workplace accidents; to be used as examples in preventive training; not to be used to identify responsibilities.
5 The Italian INAIL-ISPESL data flow Archive of claims for occupational diseases and workplace injuries, submitted and compensated. Annual updates refer to previous year Aims: to conduct epidemiological inquiries into the etiology of occupational diseases and accidents at the workplace; to plan preventive measures against occupational diseases and workplace accidents; to test the efficacy of such measures.
6 The Italian INAIL-ISPESL data flow Advantages National reference rates are provided by area and by type of economic activity. Data bases are locally available. Online access possible. Drawbacks New work-related health effects can only be investigated retrospectively based on clinical intuition (case reports) only. Late access to relevant information by the inspection agencies. Post facto attitude.
7 The Italian INAIL-ISPESL data flow Lost opportunities Early detection of emerging occupational hazards. Prevention of more serious accidents or the spreading of occupational diseases by setting inspection priorities using updated information on occupational diseases and workplace accidents. Prompt prosecution of workplace safety violations by the local OSH department.
8 OSHA Europe scopes (http://osha.europa.eu) European risk observatory Aim: to identify new and emerging risks in occupational safety and health, in order to improve the timeliness and effectiveness of preventive measures. In response to the Community Strategy on health and safety at work : anticipating new and emerging risks, whether they be linked to technical innovation or caused by social change, is vital if the risks are to be brought under control. This requires ongoing observation of the risks themselves, based on the systematic collection of information and scientific opinions.
9 How OSHA works (http://osha.europa.eu) gathering and analysing information from official registers; research literature; expert forecasts; survey data. looking for trends in order to anticipate change. effectively communicating the key issues to the target audience [which is] policy-makers and researchers.
10 Recent OSH advances in Italy Law decree 81/08, article # 8 Creates the National Information System for Prevention, aiming to addressing, planning and testing the efficacy of preventive measures against workplace injuries and occupational diseases and the inspection operations, by integrating the data available in the current information systems.
11 Current data flow of workplace injuries and occupational diseases in Italy Employer via web via regular mail INAIL automatic DB feeding scan + manual DB feeding ISPESL 1-3 years Report to the local OSH departments Analysis of the causes and circumstances Testing the efficacy of preventive measures
12 The Sardinian Health Information System Currently operative features a. SISAR: automatic health data flow at the regional level and creates ICT homogeneity among the local health unit procedures. SiSAR includes seven systems: management, epidemiology, financial, hospital admissions, preventive and home care activities, resource optimization and unique booking centre, infrastructure. b. MEDIR: creates and manages the individual clinical e-folder (FSE), which gathers and makes available online all individual health data. c. ANAGS: online demographic Register of the persons entitled to health care by the Regional Health System. It is linked online to the Local Health Units and the Population Registrars of the individual municipalities. This system certifies the patients identity.
13 The Sardinian Health Information System: scheme of an application for local early detection of workplaces at high risk of occupational diseases and workplace injuries SISAR Employer online procedure INAIL 3 months Quarterly reports to the local OSH depts Proactive prevention through planned inspections ISPESL 1-3 years Data base of occupational diseases and workplace accidents Analysis of the causes and circumstances (rates) Assessment of the efficacy of the Preventive policies
14 Example of an output to a local OSH department: workplace injuries in the previous three months Settore economico ATECO 91 Denominazione del settore economico Tasso nazionale infortuni denunciati x 10-3 Assicurati INAIL in Asl 8 infortuni infortuni osservati in ASL 8 attesi in ASL 8 A Agricoltura, caccia e silvicoltura 46,3 334,7 54 B Pesca, piscicoltura e servizi connessi 330,1 9 2 C Estrazione di minerali 73,9 565,1 7 DA Industrie alimentari, delle bevande e del tabacco 47, DB Industrie tessili e dell'abbigliamento 30,3 432,7 1 DC Industrie conciarie, fabbricazione di prodotti in cuoio, pelle e similari 30, DD Industrie del legno e dei prodotti di legno 73,0 877,8 11 DE Fabbricazione della pasta-carta, della carta e dei prodotti di carta; stampa ed editoria 35,3 1074,8 4 DF Fabbricazione di coke, raffinerie di petrolio, trattamento dei combustibili nucleari 12, DG Fabbricazione di prodotti chimici e di fibre sintetiche e artificiali 23,8 1991,2 16 DH Fabbricazione di articoli di gomma e materie plastiche 65,7 429,1 4 DI Fabbricazione di prodotti della lavorazione di minerali non metalliferi 75,0 1402,1 16 DJ Produzione di metallo e fabbricazione di prodotti in metallo 80,2 2205,8 32 DK Fabbricazione di macchine ed apparecchi meccanici, compresi l'installazione, il montaggio, la riparazione e la manutenzione 57,8 1540,4 17 DL Fabbricazione di macchine elettriche e di apparecchiature elettriche ed ottiche 28,0 1309,8 12 DM Fabbricazione di mezzi di trasporto 65,0 274,3 3 DN Altre industrie manifatturiere 57,0 658,5 8 E Produzione e distribuzione di energia elettrica, acqua e gas 29, F Costruzioni 67, ,3 124 G Commercio all'ingrosso e al dettaglio; riparazione di autoveicoli, motocicli e di beni personali e per la casa 30, ,6 139 H Alberghi e ristoranti 46, I Trasporti, magazzinaggio e comunicazioni 49,5 9354,8 98 J Intermediazione monetaria e finanziaria 6,4 1204,5 5 K Attività immobiliari, noleggio, informatica, ricerca, altre attività professionali ed imprenditoriali 27, ,5 122 L Pubblica amministrazione e difesa; assicurazione sociale obbligatoria 26, ,6 117 M Istruzione 21,7 2187,6 63 N Sanità ed altri servizi sociali 36,5 8080,5 102 O Altri servizi pubblici, sociali e personali 32,8 5005,2 34 P Servizi domestici presso famiglie e convivenze 70,3 0 3 Q Organizzazioni ed organismi extra-territoriali 11,7 0 0 Non precisato 133 TOTALE 55, , O/A L 95% CI U 95% CI 3,9 13,93 11,37 17,06 0,7 2,69 0,71 10,19 10,4 0,67 1,40 0,32 28,3 0,71 1,09 0,46 3,3 0,31 1,94 0,05 0,3 0,00 0,00 16,0 0,69 1,24 0,38 9,5 0,42 1,09 0,16 6,3 0,80 1,91 0,33 11,9 1,35 0,83 2,20 7,0 0,57 1,49 0,22 26,3 0,61 0,99 0,37 44,2 0,72 1,02 0,51 22,2 0,76 1,23 0,48 9,2 1,31 0,75 2,30 4,5 0,67 2,07 0,22 9,4 0,85 1,70 0,43 23,8 0,38 0,71 0,20 204,6 0,61 0,72 0,51 121,3 1,15 0,97 1,35 57,3 0,96 1,25 0,74 115,8 0,85 1,03 0,69 1,9 2,59 1,11 6,02 91,5 1,33 1,12 1,59 97,2 1,20 1,00 1,44 11,9 5,30 4,25 6,60 73,7 1,38 1,14 1,68 41,1 0,83 1,16 0,59 0,0 0,0 1488,7 0,77 0,82 0,73
15 The Sardinian Health Information System: data provided to the local OSH department by the application for early detection of local high risk workplaces 1. Quarterly risk of compensation claims for workplace injuries and occupational diseases by major group of economic activity within the territory of the local health unit (as in the previous example). 2. Quarterly list of workplaces within the local health unit territory in which events occurred sorted by number of events. 3. For each workplace in the list, the following information is provided: a. Number of events in the previous three months. b. Name, address and registered headquarter of the employer. 4. Further information, such as time and circumstances of each event, type of lesion or disease, and prognosis, is provided upon request
16 Towards an European Information System for Prevention of Occupational Diseases and Workplace Accidents 1. Builds up existing monitoring programs that allow a. Training the OSH personnel and the employers in each workplace. b. Training and supporting the OSH inspective operations of the local health units. c. Making available reference rates by area unit and type of industry to promptly detect local events above the expectation 2. Promotes a more extensive use of online submission of compensation claims. 3. Develops a proactive approach to Prevention by providing timely reports (every three months) to the local inspection agencies, based on the epidemiological analysis of the regular real time data input in the workplace injuries and occupational diseases data bases
17 Towards an European Information System for Prevention of Occupational Diseases and Workplace Accidents Retrospective search substantiates Existing archives of occup. disease claims and compensations Rates and denominators Cllinical reports feed ICT application providing quarterly O/E reports by Industry & area Traditional post facto approach for new discoveries Systematic proactive approach for Prevention and new discoveries