24th March: World Tuberculosis Day

March 24^th has been set aside annually to create public awareness and celebrate the achievements made so far in eradication of Tuberculosis the world over. The theme for 2013 was “Stop TB in my lifetime, call for a world free of TB” and there is a call to all government, private institutions, civil societies, health care providers, medical associations, non-governmental organizations to work towards the total eradication of the tuberculosis (TB) disease.

Setting this day aside each year provides an opportunity to create awareness on the incidence of TB worldwide, gives an update on the progress made on the prevention and control and helps to solicit for support from government and international organizations.   

TB mortality rate has reduced by over 40% worldwide since 1990 with a decline in occurrence of new incidence of the disease, Although TB occurs mostly among low to middle income earners; it is a risk to all due to the airborne nature. The World Health Organization statistics states that 1.4 million people died from TB in the year 2011.

The objective of this write-up is to enlighten people on TB as a disease, its causes and treatment.

Dr. Robert Koch first discovered the cause of TB on 24th March 1882 hence the memorial for the global awareness. It is caused by a bacterium called Mycobacterium tuberculosis, which usually attack the lungs but can also affect other parts of the body such as kidney, spine and brain; it can be fatal if not treated properly. It is an airborne disease that usually gets into the air from an infected person that coughs, sneezes, speaks or sings and then anyone who breathes in the bacteria becomes infected.

Two types of TB infected conditions exist: the latent TB infection and the TB disease:

Latent TB Infection: The TB bacteria can live in the body without making you sick. For most people that breathe in the bacteria and become infected, the immune system fights to stop the bacteria from growing therefore there are no symptoms. People with latent TB are not infectious or cannot spread the disease to others but if the TB bacteria become active in the body and multiply, the person will become sick therefore will change from having latent TB to having the TB disease. About 90% of all infections are latent and asymptomatic.

TB Disease: When a person breathes in TB bacteria, it multiplies in the body, the individual becomes sick and becomes infectious to other people. Some people develop TB disease within weeks after becoming infected before their immune system can fight the TB bacteria. Symptoms include bad cough, pain in the chest, coughing up blood or sputum, weakness or fatigue, weight loss, no appetite, chills, fever, sweating at night.

Risk Factors: In Sub-Saharan Africa where HIV rates are high, more people are susceptible to TB infections because the two diseases co-exist; overcrowding, poor nutrition and smoking are all factors that make people more susceptible to TB infections.

Diagnosis: Diagnosing active TB based on signs and symptoms is difficult; a definitive diagnosis can only be made by identifying the bacteria in a clinical sample such as sputum, pus or biopsy from tissue. The TB organism is slow growing so can take from two to six weeks for the culture to process. The Mantoux tuberculin skin test is often used to screen people at high risk for TB.

Prevention: Control and prevention of TB is by vaccination of infants while for active cases, detection and appropriate treatment is advised. The currently available vaccine is Bacillus Calmette- Guerin (BCG), which gives immunity for about 10years.

Management and treatment: Antibiotics can be used to kill the bacteria, the most effective antibiotics are isoniazid and rifampicin and treatment can take several months. Latent TB treatment uses a single antibiotics’ while the active TB disease is best treated using a combination of different antibiotics to reduce the risk of the bacteria becoming resistant to the antibiotics.

Achieving a world free of TB is a journey we must all embark on to ensure we stop TB in our lifetime.

Written by O’ Reese of En-pact Solutions Limited, 2013

Twitter: @O Reese2

         @EnpactHSE

Gas Cylinder Safety

Gas cylinders are a convenient way to store and transport gases under pressure. These gases can be used for different purpose including industrial use, extinguishing fires, cooking and heating. The main hazards associated with the use, storage and handling of compressed gas cylinders are: the chemical hazard associated with the cylinder contents (corrosive, toxic, flammable, etc.) and the physical hazards represented by the presence of a high-pressure vessel in a room.  

With the phasing out of firewood (coal) and cooking stove, most homes in the urban areas of Nigeria now use gas cylinders as a source of fuel for cooking due to technological advancement and adoption of cleaner technologies, better lifestyle and convenience of cooking.

                                                                                                           

Cylinders that contain compressed gases or any type of gas have to meet various construction and installation standards and they must come equipped with a variety of safety features.  Incidents involving compressed gases can be very fatal due to the highly flammable nature of their contents. Sometimes workers don't recognize the hazards associated with the gases and so they don't take protective measures or they may not appreciate that while the cylinders are heavy, they are also very delicate and hazardous and require very careful handling and storage. Each gas has its own specific hazards, and you have to check your MSDS (Material Safety Data Sheets) to make sure you are following the precautions required to use a particular gas safely.

General Hazards

The hazards of compressed gases vary, but most fall into these general categories:

·       Fire (resulting from escape of flammable gasses or fluids)

·       Explosion (from the blast or rapid release of compressed gas)

·       Release of toxic substances (released gas or fluids)

·       Manual handling injuries

·       Impact from falling cylinders or valves

Most compressed gases will burn or explode under the right circumstances and, without adequate care and planning could lead to accidents.

Protection against Hazards

The United States OSHA (Occupational Safety and Health Administration) regulations highlight a number of tips to prevent accidents with compressed gas cylinders.

·       Identification:  Each cylinder should be marked with its identity, so you know which MSDS to check to find out about hazards associated with its use. 

·       Storage: Compressed gases have to be stored in a dry well-ventilated area at least 20 feet from combustible materials, away from any heat source or electrical wiring, stored on a level fireproof floor where they won't be banged or knocked over, and secured upright by chain, cable, or something similar.

·       When cylinders are in storage, valves have to be closed and valve protection caps should be screwed down to the last thread.

·       Organize the storage area so that you always go for the cylinders that have been in there longest.  Put the newest ones received in the back. Apply the FIFO rule = First IN, First OUT

·       Transporting:  There's a lot of potential for accidents when you're moving gas cylinders, the safest way to move them is to secure them in an upright position

·       Mishandled cylinders may rupture violently, release their hazardous contents or become dangerous projectiles. If a neck of a pressurized cylinder should be accidentally broken off, the energy released would be sufficient to propel the cylinder to over three-quarters of a mile in height like a missile.

Safe Handling and Use Guidelines:

One has to be extremely careful when handling compressed gas cylinders, so they don't come in contact with anything that could create fire or explosion.

·       Don't purchase a larger cylinder size than necessary, excess reactant can be a problem for disposal, increases the risk to a larger area if accidentally released and is more difficult to store in a ventilated area if required.

·     Before connecting a gas cylinder to equipment make sure that the regulator and equipment are suitable for the type of gas and pressure being used.

·     When required, wear suitable safety shoes and other personal protective equipment when handling gas cylinders.

·       Fire extinguishing equipment should be readily available when combustible materials can be exposed to welding or cutting operations using compressed cylinder gases

·       Do not use gas cylinders for any other purpose than the transport and storage of gas.

·       When the cylinder is not in use the valve protection cap must be in place to protect the valve; never transport without the regulator in place

·       Never drag, slide or roll the cylinder - get a cylinder cart or truck and use it

·       Cylinders should not be hoisted by wrapping slings around them but should be secured in an approved rack or cylinder truck during transportation.

Special precautions are also required when storing cylinders:

·       They must be secured at a point approximately 2/3 of its height, using appropriate material.

·       As with any hazardous material, you may not store gas cylinders in public hallways or other unprotected areas.

·       Cylinders must be secured individually, i.e., one restraint per cylinder.

·       Cylinders should be segregated in hazard classes while in storage, at the minimum, oxidizers (such as oxygen) must be separated from flammable gases, and empty cylinders should be isolated from filled cylinders.

·       Cylinders shall not be placed where they may be exposed to an electrical arc or sparks, slag, flame, or other heat sources.

·       Keep cylinders on the outside of buildings in closed structures where possible.

Before the cylinder is first used the following precautions should be taken:

·       Make sure the cylinder is equipped with the correct regulator. Always use the regulator designed for the material in use, and be especially careful that under no circumstances is grease or oil used on regulator or cylinder valves because these substances may cause an adverse, dangerous reaction within the cylinder

·       The cylinder should be placed so that the valve handle at the top is easily accessible at all times

·       Open the valve slowly and only with the proper regulator in place - the valve should be opened all the way. Never leave a valve half way open - either open it all the way or close it all the way

·       The valve should never be left open when equipment is not in use, even when empty; air and moisture may diffuse through an open valve, causing contamination and corrosion within the cylinder

This covers general safety procedures that all employees should be aware; keep your eye out for improperly stored gas cylinders, or gas cylinders that are being used without the proper safety precautions.

A quick note for those people that use gas for cooking: 

·     Ensure that your gas stove gets serviced once a year

·     Every time you change the gas cylinder, look at the regulator and the regulator tubing to ensure that it is still in good condition

·     Ensure that the gas stove is switched off properly.

·     Teach your children and domestic staff on the dangers of gas cylinders

·     If you ever smell gas, DO NOT TRY TO SWITCH A LIGHT OR A TORCH OR A MATCH OR YOUR CELL PHONE.  All these things have the potential to cause a spark that will ignite the leaking gas and explode.  Instead, leave the house immediately and call for help. If possible, open all windows and doors, switch off the gas cylinder and wait for the technician to come and do it for you.

Remember - the greatest physical hazard represented by the compressed gas cylinder is the tremendous force that may be released if it is knocked over!

Written by O'Reese of En-pact Solutions Limited, 2013

Twitter:

@OReese2

@EnpactHSE

March Tips………Manual Handling Safety

Manual Handling involves lifting, carrying, pushing, stacking or laying down objects without the use of mechanical equipments.

Incorrect Manual Handling is a major cause of injuries at work. It is the cause of the most frequently reported musculoskeletal disorder injury which is back strain.

These injuries CAN be prevented by using the following basic steps:

·       Avoid the need for manual handling, as much as possible;

·       Assess the risk of injury from any manual handling that cannot be avoided.

·       Avoid lifting anything over 40 lbs. or 18 kg without help or a lifting device.

The following should be taken into consideration when lifting manually; this could be used as a simple guide.

Pre-Manual Handling Examination

·       Can mechanical aids be used e.g. mobile lifting gear, forklift, trolleys etc.?

·       Check the weight, check the center of gravity and stability.

·       If necessary make a trial lift.

·       Are there sharp edges?

·       Is the load too heavy, too large or awkward?

·       Can someone else help? Many hands make light work.

Plan

·       Eliminate trip or slip hazards from the path to be travelled.

·       Decide in advance how to handle the load.

·       Package load so as not to obscure vision.

·       Plan for opportunities to rest and recover, avoid long distance without rest.

·       Know where to unload: Has it been identified, is a spot cleared for it?

Good grip

·       Keep object close to the body.

·       Grasp firmly with both hands and ensure a good posture.

·       Lift, keeping the back straight with relaxed muscles, arms close to body, leg muscles taking the strain.

·       Step off in the direction- advance foot pointing, with load held close to the body.

·       Watch your fingers!

·       When lifting to a height from the floor do it in two stages

Potential Risk

Back injury can occur during manual lifting on and off the job, from warehouse operations to picking up boxes of photocopying paper in the office or trying to move a generator at home.

A prevalent cause of back injury is poor manual handling technique due to the following:

·       If the load is heavier than the person is capable of lifting and supporting, the load can become unbalanced causing the individual to lean far forward thereby stretching the upper part of the spine putting a strain on the lumber region resulting in a herniated disc.

·       If an incorrect lifting practice is used and excessive strain is imposed on the back

·       If the body is twisted during lifting, this will result in the heavy load being placed on the spine in a weak unsupported position which can cause dislocated disc

·       If the loads are lifted or carried continuously without break, this may result in chronic backache over a period of time.

Here’s how to spare your spine!

·       Footing is as important in lifting, keep feet close to the object; far enough apart for good balance (about shoulder-width). One foot slightly ahead works best.

·       Bend knees; go down to a crouch, but not a full squat. It takes double the effort to straighten up from a full squat as it does from a crouch.

·       Keep back as straight as possible; don't arch it.

·       Get a good, firm grip; no lifting until your hold is strong and slip-proof.

·       Lift object by straightening your legs, keeping load close to you as you come up.

·       If you have to change direction, don't twist body. Lift object to carrying position, then your whole body by changing position of your feet.

·       In setting load down, go down with back straight, knees bent, to a crouch.

Use of Personal Protective Equipment

·       Gloves must be worn to protect against cuts, scratches or punctures.

·       Wear safety boots or shoes to protect toes from falling loads and to prevent from slipping

Correct Lifting Techniques

Written by O’ Reese of En-pact Solutions Limited, 2013

Twitter: @O Reese2

         @EnpactHSE