Costs of occupational injury and illness across industries

How to prevent 3 million deaths worldwide: a systematic review of occupational accident research-a factor- and cost-based approach

Occupational accidents have emerged as a global concern, necessitating a comprehensive examination of their determinants and associated costs. This review aims to summarize, synthesize, and organize the factors and cost drivers of occupational accidents, exploring whether there is a gender perspective. Adhering to PRISMA guidelines, we performed a narrative synthesis to systematically review relevant literature. A systematic search was conducted in the electronic databases PubMed, Web of Science, and Scopus. Two researchers screened all records to eliminate any duplicates, and they selected the articles for full review. A third researcher was consulted to resolve discrepancies and reach a consensus. The analysis of 15 studies revealed diverse perspectives; in terms of determinants, studies on organizational aspects and the theory of human error were grouped together, while in cost drivers, the human capital model and willingness to pay were the most frequently used. Gender, meanwhile, is identified as a determinant variable for accident rate. Additionally, limitations such as data underestimation were noted in the existing literature. The review highlights the need for empirical studies capable of addressing both determinants and cost drivers. It also provides guidelines for researchers to design studies that are more comparable across different contexts, including the gender debate.

Hearing Conservation Programme Costs at Selected South African Companies

The Occupational Health and Safety Act 1993 and its attending Regulations in South Africa, require employers to conduct cost analysis studies to inform decision-making related to exposure control for occupational health hazard such as noise. Cost analysis, as per South African National Standard/ISO 31000 risk assessment guideline, is an important input for the decision-making process of the risk management process. The costs of administrating a hearing conservation programme intended to minimise noise-induced hearing loss is an example of a cost analysis. This study enrolled four companies from the South African manufacturing and utilities sectors with the aim of establishing whether cost analysis is included during the noise risk assessment process; and determining administration costs of HCP administration. A HCP cost questionnaire was completed by each company's occupational hygiene professionals and risk officers. None of the companies in the study included cost analysis in their respective risk assessment processes. The overall costs, derived from the HCP cost item questionnaire, was much greater for Company A (4 290 014 Rands) than all of the other companies combined (970 685 Rands). Hearing protection device expenditures across the four companies were the greatest expense, while audiometry was the smallest expense owing to service internalisation. The HCP expenditures are incurred on periodic basis, yearly or biennial, and are internalised in companies as direct costs. Cost analysis can enhance the noise risk assessment process by providing additional input to support the decision-making process related to noise control. This challenges the occupational hygiene profession to pursue new frontiers and decision-making models in the scope of noise risk management, beyond noise measurements and hearing protection device use recommendation.

Cleaning in the 21st Century: The musculoskeletal disorders associated with the centuries-old occupation - A literature review

Workers performing cleaning duties experience higher injury rates, especially in the form of musculoskeletal disorders (MSDs), than other industries. It is essential to understand the inherent risks associated with the nature of this occupation. Based on the Balance Theory (Smith & Carayon-Sainfort, 1989), this review surveys the current literature, especially those published since the previous review paper (Kumar & Kumar, 2008), and identifies which elements contributing to MSD risks were examined: task, technology, organization, environment, individual, and their interactions. Thirty-nine research papers published between 2005 and 2021 are identified and summarized. Among these papers, task and individual elements received the most attention, at 42 and 34 occurrences, respectively. The interaction elements of technology-organization, technology-environment, and organization-environment received less than three mentions. The goal of this literature review is to update the knowledge base and identify current trends for the cleaning occupation. Possible interventions for risk reduction and future research directions are suggested.

Work-Related Injuries among Insured Construction Workers Presenting to a Swiss Adult Emergency Department: A Retrospective Study (2016-2020)

Occupational injuries are one of the main causes of Emergency Department visits and represent a substantial source of disability or even death. However, the published studies and reports on construction-occupational accidents in Switzerland are limited. We aimed to investigate the epidemiology of fatal and non-fatal injuries among construction workers older than 16 years of age over a 5-year period. Data were gathered from the emergency department (ED) of Bern University Hospital. A retrospective design was chosen to allow analysis of changes in construction accidents between 2016-2020. A total of 397 patients were enrolled. Compared to studies in other countries, we also showed that the upper extremity and falling from height is the most common injured body part and mechanism of injury. Furthermore, we were able to show that the most common age group representing was 26-35 years and the second common body part injured was the head, which is a difference from studies in other countries. Wound lacerations were the most common type of injury, followed by joint distortions. By stratifying according to the season, occupational injuries among construction workers were found to be significant higher during summer and autumn. As work-related injuries among construction workers are becoming more common, prevention strategies and safety instructions must be optimized.

Metal biomonitoring using fractioned dust to investigate urinary and oxidative stress biomarkers among occupationally exposed chromite mine workers

Exposure to heavy metals has been associated with the generation of reactive oxygen species (ROS) among exposed individuals in occupational and environmental settings. Dust is considered a significant contributor to airborne metal exposure, and previous data suggest that their levels in dust may vary based on its particle sizes. However, no biomonitoring study has been reported so far to address the metal-induced oxidative stress using different dust fractions, particularly in occupational settings. We designed a systematic cross-sectional study involving 110 chromite mine workers stratified into loaders (n = 28), extractors (n = 47) and operators (n = 35), and controls (n = 30) to find out the association between dust-bound metal exposure and oxidative stress using urinary creatinine-adjusted metal level as a biomarker of metal exposure. Results suggested elevated urinary levels of Cr 51.34 ± 8.6 along with Pb 34.29 ± 4.39, Cd 21.1 ± 2.6, and Ni 18.98 ± 3.01 µg/g creatinine in exposed (extractor group) workers. Correlating metal levels with oxidative stress revealed elevated malondialdehyde (MDA) levels of 62.28 ± 5.52 nM/dl among the extractors showing high levels of lipid peroxidation. Furthermore, blood superoxide dismutase (SOD) was also found significantly correlated (P = 0.000) with urinary toxic metal levels among exposed workers. We report the association between metal exposure and oxidative stress in exposed mining workers that may give rise to workers' susceptibility towards genetic and non-genetic health implications. The current study emphasized on the need for exposure control measures in the chromite ore mining activity areas.

Work-related injury burden, workers' compensation claim filing, and barriers: Results from a statewide survey of janitors

BACKGROUND

Janitors are a low-wage, ethnically and linguistically diverse, hard-to-reach population of workers with a high burden of occupational injury and illness.

METHODS

Data from an extensive multimodal (mail, phone, web) survey of janitors in Washington State were analyzed to characterize their working conditions and occupational health experiences. The survey included questions on demographics, work organization and tasks, health and safety topics, and discrimination and harassment. The survey was administered in eight languages.

RESULTS

There were 620 complete interviews. The majority completed the survey by mail (62.6%), and in English (85.8%). More than half of responding janitors were female (56.9%), and the mean age was 45 years. Twenty percent reported having a (health-care-provider diagnosed) work-related injury or illness (WRII) in the past twelve months. Women and janitors who were Latino had significantly higher relative risk of WRII. Increased risk was also associated with several work organization factors that may indicate poor working conditions, insufficient sleep, and possible depression. Half of injured janitors did not file workers' compensation (WC) claims.

CONCLUSIONS

Janitors reported a high percentage of WRII, which exceeded previously published estimates from Washington State. Women and Latino janitors had significantly increased risk of WRII, and janitors' working conditions may influence the unequal distribution of risk. WRII surveillance via WC or medical care usage in janitors and other low-wage occupations may reflect substantial underreporting. Characterizing the nature of janitors' work experience can help identify avenues for prevention, intervention, and policy changes to protect the health and safety of janitors.

Contributing effects of individual characteristics, behavioural and job-related factors on occurrence of mining-related injuries: A systematic review

BACKGROUND

Occupational health and safety (OHS) is a complex system due to its three components, namely human, technological and organizational factors. The interplay between the three systems causes workplace accidents and, subsequently, injuries. The body of research currently available demonstrates a disparity in the focus on contributors that cause mining-related injuries beyond the presence of hazards.

OBJECTIVE

The aim of this paper was to systematically review and synthesise peer-reviewed published studies that have investigated whether certain individual characteristics, behavioural factors and job-related factors predict mining-related injuries.

METHODS

Databases were searched and peer-reviewed publications from 2004 to 2020 were retrieved and analysed. Only 24 from 3073 identified articles were retained for review and synthesis following careful screening. Most identified studies were either cross-sectional or case-control studies, and they were rated as moderate-to-good quality.

RESULTS

The review results showed that there is a diverging view in relation to risk factors that cause mining-related injuries. Some publications suggested that old age, male miners, married miners, less educated miners, less experienced miners, alcohol and drug usage, poor working conditions, poor management or supervision, job dissatisfaction and job stress predict injury events while other studies found contradictory relationships or insignificant statistical associations.

CONCLUSIONS

Despite the fact that studied risk factors have been well-established in other industries, there is a significant gap in mining that needs further examination. It is imperative that health and safety intervention strategies are devised and implemented for vulnerable groups.

Development of Framework for Estimating Fatality-Related Losses in the Korean Construction Industry

The number of fatalities in the construction industry is highest among all industries; thus, various losses in the form of fatalities in construction represent a significant factor for safety management. If a fatality occurs, it is important to estimate the overall loss, as a significant financial loss occurs for each project participant. However, in studies of the cost of accidents involving a fatality conducted abroad, the framework cannot be applied as it is because insurance types, systems, and legal cost systems differ by country. Therefore, we developed a framework for calculating the fatality loss considering various aspects of labor, industry, and regulations in Korea. This was done in four steps: (i) data collection and criteria selection; (ii) proposed framework development; (iii) conduct of questionnaire surveys for the case study; and (iv) analysis and evaluation of the case study. As a result of the data analysis after the case study of general construction companies, the total fatality loss was estimated to be 2,198,260 USD/person. The contributions of this study are the development of a framework composed of newly discovered items that can acquire reliable data in consideration of the properties of the construction industry.

Kneeling trunk kinematics during simulated sloped roof shingle installation

Trunk musculoskeletal disorders are common among residential roofers. Addressing this problem requires a better understanding of the movements required to complete working tasks, such as affixing shingles on a sloped residential roof. We analyzed the extent to which the trunk kinematics during a shingling process are altered due to different angles of roof slope. Eight male subjects completed a kneeling shingle installation process on three differently sloped roof surfaces. The magnitude of the trunk kinematics was significantly influenced by both slope and task phase of the shingling process, depending on the metric. The results unequivocally point to roof slope and task phase as significant factors altering trunk kinematics. However, extension of the results to roofing workers should be done carefully, depending on the degree to which the study protocol represents the natural setting. Future studies on shingle installation in residential roofing should absolutely consider capturing a wider array of shingling procedures in order to encapsulate all the possible methods that are used due to the lack of a standardized procedure.

A Systems Evaluation of Occupational Injuries and Illness in the US Army

OBJECTIVE

Workers' compensation (WC) processes do not lead to maximal return-to-work or cost savings. The aim of this study is to assess barriers and facilitators to reporting and managing injuries and illnesses among civilian employees in the US Army.

METHODS

We triangulated a review of policy and practice documents, stakeholder interviews, a descriptive analysis of WC data, and a literature review to inform recommendations of best practices for improving return-to-work and lowering WC costs.

RESULTS

Federal WC costs are trending downward for civilian employees in the US Army; however, the approaches are not uniform or optimized, especially at the installation level.

CONCLUSIONS

This mixed methods evaluation of the Department of Defense WC elucidates areas for improvement and potential best practices within the Federal WC system.

Analysis of Injuries in the Ghanaian Mining Industry and Priority Areas for Research

BACKGROUND

Despite improvements in safety performance, the number and severity of mining-related injuries remain high and unacceptable, indicating that further reduction can be achieved. This study examines occupational accident statistics of the Ghanaian mining industry and identifies priority areas, warranting intervention measures and further investigations.

METHODS

A total of 202 fatal and nonfatal injury reports over a 10-year period were obtained from five mines and the Inspectorate Division of the Minerals Commission of Ghana, and they were analyzed.

RESULTS

Results of the analyses show that the involvement of mining equipment, the task being performed, the injury type, and the mechanism of injury remain as priorities. For instance, mining equipment was associated with 85% of all injuries and 90% of all fatalities, with mobile equipment, component/part, and hand tools being the leading equipment types. In addition, mechanics/repairmen, truck operators, and laborers were the most affected ones, and the most dangerous activities included maintenance, operating mobile equipment, and clean up/clearing.

CONCLUSION

Results of this analysis will enable authorities of mines to develop targeted interventions to improve their safety performance. To improve the safety of the mines, further research and prevention efforts are recommended.

Manual patient transfers: factors that influence decisions and kinematic strategies employed by nursing aides

While extensive literature has characterised factors that influence the acceptable mass of 'boxes' during MMH tasks, less is known about these factors when moving 'people' in healthcare settings. This study examined factors that influence decisions/approaches employed during manual patient transfers. Sixteen nursing aides manually-transferred a standardised 'patient'; patient mass was adjusted (using a weight vest) to determine a maximum acceptable patient mass for this task (mass_max). Grip strength was the only worker characteristic significantly associated with mass_max (r = 0.48). Older worker age was associated with smaller peak trunk flexion (r =  -0.58) and shoulder abduction (r =  -0.59), and greater trunk axial twist (r = 0.52). Workers emphasised that patient characteristics (e.g. physical/cognitive status) influenced their decisions when performing transfers. These findings extend previous literature by suggesting that grip strength is a useful predictor of perceived work capacity, older workers adapt protective postural strategies during patient transfers and worker-patient dynamics are crucial during this high-risk occupational task. Practitioner Summary: This study examined manual patient transfers performed by nursing aides. Worker grip strength (but not age or size) was associated with perceptions of maximum acceptable patient mass. Kinematic changes suggested more conservative strategies used by older workers. Workers emphasised that patient characteristics substantially influenced their decisions when performing transfer tasks.

Lower extremity kinematics of cross-slope roof walking

Working conditions of residential roofers expose them to a unique sloped environment. The purpose of this study is to determine in what way traversing across a sloped/roof surface alters lower extremity kinematics of the upslope and downslope legs compared to level walking. College aged males negotiated across a pitched (26 degrees) roof segment during which lower extremity three-dimensional kinematics were calculated. One foot was higher on the slope and one was lower for the duration of cross slope walking. Overall, cross-slope walking on a 26 degree roof significantly altered 77% of the measured lower extremity variables compared to level self-selected pace walking. The data suggest that roof pitch incite significant differences in crossslope walking of the kinematics in the lower extremity between the upslope and down slope limbs when compared to level surface walking. These alterations could temporarily alter proprioception which may in turn lead to increased falls and musculoskeletal injury, though further study is needed.

Biomechanical investigation of prolonged driving in an ergonomically designed truck seat prototype

A postural evaluation during a prolonged driving task was conducted to determine the ergonomic validity of a new freely adjustable truck seat prototype. Twenty participants were recruited to perform two 2-h simulated driving sessions. Postures were assessed using motion capture, accelerometers and pressure pads. Subjective discomfort was also monitored in 15-min increments using ratings of perceived discomfort (RPD) and the Automotive Seating Discomfort Questionnaire. Participants had a more neutral spine posture during the first hour of the drive and reported lower RPDs while sitting in the prototype. Pairing the gluteal backrest panel with the adjustable seat pan helped reduce the average sitting pressure. The industry-standard truck seat may lead to the development of poor whole body posture, and the proposed ergonomic redesign of a new truck seat helped improve sitting posture and reduce perceived discomfort. Practitioner Summary: A new freely adjustable truck seat prototype was compared to an Industry standard seat to assess hypothesised improvements to sitting posture and discomfort for long haul driving. It was found that the adjustable panels in the prototype helped promote spine posture, reduce sitting pressure and improved discomfort ratings.

Work-related injuries among commercial janitors in Washington State, comparisons by gender

INTRODUCTION

We analyzed workers' compensation (WC) data to identify characteristics related to workers' compensation claim outcomes among janitorial service workers in Washington State.

METHOD

We analyzed WC data from the Washington State Department of Labor & Industries (L&I) State Fund (SF) from January 1, 2003 through December 31, 2013, for janitorial service workers employed in the National Occupational Research Agenda (NORA) Services Sector. We constructed multivariable models to identify factors associated with higher medical costs and increased time lost from work.

RESULTS

There were 2,390 janitorial service compensable claims available for analysis. There were significant differences in injury type and other factors by gender, age, and language preference. Linguistic minority status was associated with longer time loss and higher median medical costs. Women were estimated to account for 35% of janitorial service workers but made up 55% of the compensable claims in this study.

CONCLUSIONS

Janitorial service workers comprise a large vulnerable occupational group in the U.S. workforce. Identifying differences by injury type and potential inequitable outcomes by gender and language is important to ensuring equal treatment in the workers' compensation process.

PRACTICAL APPLICATIONS

There were significant differences in injury and individual characteristics between men and women in this study. Women had twice the estimated rate of injury to men, and were more likely to require Spanish language materials. Improving communication for training and knowledge about the workers' compensation system appear to be high priorities in this population of injured janitorial service workers.

Work-related injury factors and safety climate perception in truck drivers

INTRODUCTION

The trucking industry has a high burden of work-related injuries. This study examined factors, such as safety climate perceptions, that may impact injury risk.

METHOD

A random sample of 9800 commercial driver's license holders (CDL) were sent surveys, only 4360 were eligible truck drivers. Descriptive statistics and logistic regression models were developed to describe the population and identify variables associated with work-related injury.

RESULTS

2189 drivers completed the pertinent interview questions. Driving less-than-truckload, daytime sleepiness, pressure to work faster, and having a poor composite score for safety perceptions were all associated with increased likelihood of work-related injury. Positive safety perception score was protective for odds of work-related injury, and increased claim filing when injured.

CONCLUSIONS

Positive psychological safety climate is associated with decreased likelihood of work-related injury and increased likelihood that a driver injured on the job files a workers' compensation claim.

The economic burden of lung cancer and mesothelioma due to occupational and para-occupational asbestos exposure

OBJECTIVES

To estimate the economic burden of lung cancer and mesothelioma due to occupational and para-occupational asbestos exposure in Canada.

METHODS

We estimate the lifetime cost of newly diagnosed lung cancer and mesothelioma cases associated with occupational and para-occupational asbestos exposure for calendar year 2011 based on the societal perspective. The key cost components considered are healthcare costs, productivity and output costs, and quality of life costs.

RESULTS

There were 427 cases of newly diagnosed mesothelioma cases and 1904 lung cancer cases attributable to asbestos exposure in 2011 for a total of 2331 cases. Our estimate of the economic burden is $C831 million in direct and indirect costs for newly identified cases of mesothelioma and lung cancer and $C1.5 billion in quality of life costs based on a value of $C100 000 per quality-adjusted life year. This amounts to $C356 429 and $C652 369 per case, respectively.

CONCLUSIONS

The economic burden of lung cancer and mesothelioma associated with occupational and para-occupational asbestos exposure is substantial. The estimate identified is for 2331 newly diagnosed, occupational and para-occupational exposure cases in 2011, so it is only a portion of the burden of existing cases in that year. Our findings provide important information for policy decision makers for priority setting, in particular the merits of banning the mining of asbestos and use of products containing asbestos in countries where they are still allowed and also the merits of asbestos removal in older buildings with asbestos insulation.

Narrative and quantitative analyses of workers' compensation-covered injuries in short-haul vs. long-haul trucking

Trucking remains one of the most dangerous industries in the U.S. Study aims were to (1) identify differences in worker injury types; (2) describer typical injury scenarios; and (3) recommend injury control measures, in short-haul vs. long-haul trucking. Narrative text analyses of Kentucky short-haul and long-haul trucking workers' compensation first reports of injury were performed. A higher percentage of lifting and cranking injuries were identified in short-haul trucking compared with long-haul trucking that had a higher percentage of securing/opening/closing/adjusting injuries that involved tarping, trailer door handling, and cab slippage. In contrast, a higher proportion of short-haul trucking injury scenarios involved roadway departures and rear-end collisions. Study findings can be used to inform intrastate vs. interstate trucking injury prevention control strategies such as an enhanced driver safety training and safe freight handling in short-haul trucking, and tarping, trailer safety, and cab safety in long-haul trucking.

Costs of Occupational Injury and Illness within the Health Services Sector

Knowledge of costs is essential to allocate medical resources efficiently. The authors' goal was to estimate and compare costs across occupations, industries, gender, race, and types of nonfatal injuries and illnesses. This is an incidence study of nationwide data, 1993. Nonfatal incidence data were drawn from the Bureau of Labor Statistics Annual Survey. Medical costs were from the Detailed Claims Information data set. Productivity (wage) costs were calculated using the Current Population Survey. Pain and suffering costs were estimated from data on jury verdicts. Injuries and illnesses to nursing aides and orderlies cost $2,200 million; costs were $900 million for registered nurses and $40 million for licensed practical nurses. The ranking of health services industries in terms of costs was: hospitals (52 percent of all costs), nursing care facilities (38 percent), home care services (6 percent), physicians' offices (4 percent), and laboratories (<1 percent). Types of injuries (sprains, strains, fractures) were similar across occupations and industries, but types of illness (carpal tunnel syndrome, respiratory diseases) varied. The most costly injured body parts were: back, shoulder, knee, wrist, and neck. Injuries and illnesses comprised roughly 90 percent and 10 percent, respectively, of total costs. The hospital industry was the third most expensive of 313 U.S. industries. Costs of occupational injury and illness in the health services industry were high and varied across occupation, industry, disease, race, and gender.

Incidence and lifetime costs of injuries in the United States

BACKGROUND

Standardized methodologies for assessing economic burden of injury at the national or international level do not exist.

OBJECTIVE

To measure national incidence, medical costs, and productivity losses of medically treated injuries using the most recent data available in the United States, as a case study for similarly developed countries undertaking economic burden analyses.

METHOD

The authors combined several data sets to estimate the incidence of fatal and non-fatal injuries in 2000. They computed unit medical and productivity costs and multiplied these costs by corresponding incidence estimates to yield total lifetime costs of injuries occurring in 2000.

MAIN OUTCOME MEASURES

Incidence, medical costs, productivity losses, and total costs for injuries stratified by age group, sex, and mechanism.

RESULTS

More than 50 million Americans experienced a medically treated injury in 2000, resulting in lifetime costs of $406 billion; $80 billion for medical treatment and $326 billion for lost productivity. Males had a 20% higher rate of injury than females. Injuries resulting from falls or being struck by/against an object accounted for more than 44% of injuries. The rate of medically treated injuries declined by 15% from 1985 to 2000 in the US. For those aged 0-44, the incidence rate of injuries declined by more than 20%; while persons aged 75 and older experienced a 20% increase.

CONCLUSIONS

These national burden estimates provide unequivocal evidence of the large health and financial burden of injuries. This study can serve as a template for other countries or be used in intercountry comparisons.

Injury Profiles Associated with Artisanal and Small-Scale Gold Mining in Tarkwa, Ghana

Artisanal and small-scale gold mining (ASGM) is inherently risky, but little is known about mining-associated hazards and injuries despite the tremendous growth worldwide of ASGM and the benefits it offers. The current study aimed to characterize the physical injuries associated with ASGM in Ghana to guide policy formulation. A cross-sectional survey was carried out in the Tarkwa mining district of the Western Region of Ghana in 2014. A total of 404 small-scale miners were recruited and interviewed regarding their occupational injury experiences over the preceding 10 years using a paper-based structured questionnaire. Nearly one-quarter (23.5%) of the miners interviewed reported getting injured over the previous 10 years, and the overall injury rate was calculated to be 5.39 per 100 person years. The rate was significantly higher for women (11.93 per 100 person years) and those with little mining experience (e.g., 25.31 per 100 person years for those with less than one year of work experience). The most injury-prone mining activities were excavation (58.7%) and crushing (23.1%), and over 70% of the injuries were reported to be due to miners being hit by an object. The majority of the injuries (57%) were lacerations, and nearly 70% of the injuries were to the upper or lower limbs. Approximately one-third (34.7%) of the injuries resulted in miners missing more than two weeks of work. One-quarter of the injured workers believed that abnormal work pressure played a role in their injuries, and nearly two-fifths believed that their injuries could have been prevented, with many citing personal protective equipment as a solution. About one-quarter of the employees reported that their employers never seemed to be interested in the welfare or safety of their employees. These findings greatly advance our understanding of occupational hazards and injuries amongst ASGM workers and help identify several intervention points.

Quality management and federal workers' compensation: the Veterans Health Administration workers' compensation program model

OBJECTIVE

The federal workers' compensation program includes under a single employer five commonly encountered roles and responsibilities-injured patient, clinical provider, third-party administrator, adjudicator, and insurer. Data within the Veterans Health Administration (VHA) provide a unique opportunity to apply a simple model of health care quality improvement, exploring interactions between structures, processes, and outcomes.

METHODS

A facility survey identified reporting structures, levels of education and training, policies and processes, tool availability and use, and perceptions of role adherence. Administrative data included process and outcome metrics, including short-term disability, long-term disability, and lost time cases.

RESULTS

Improved collaboration between clinical and administrative staff within VHA and with the Department of Labor was associated with improved performance.

CONCLUSIONS

Applying a clinical quality improvement model clarifies roles, expectations, and likely relationships for improved program management.

Prioritizing industries for occupational injury prevention and research in the Services Sector in Washington State, 2002-2010

Background

The Services Sector, as defined by the National Occupational Research Agenda (NORA), is comprised of a diverse industry mix and its workers face a variety of occupational exposures and hazards. The objective of this study was to identify high-risk industry groups within the Services Sector for prevention targeting.

Methods

Compensable Washington State workers’ compensation claims from the Services Sector from 2002 through 2010 were analyzed. A “prevention index” (PI), the average of the rank orders of claim count and claim incidence rate, was used to rank 87 Services Sector industry groups by seven injury types: Work- Related Musculoskeletal Disorders (WMSDs), Fall to Lower Level, Fall on Same Level, Struck By/Against, Caught In/Under/Between, Motor Vehicle, and Overexertion. In the PI rankings, industry groups with high injury burdens appear higher ranked than industry groups with low counts or low rates of injury, indicating a need for prioritizing injury prevention efforts in these groups.

Results

In the Services Sector, these 7 injury types account for 84% of compensable claims in WA. The industry groups highest ranked by PI across the injury types included: Services to Buildings and Dwellings; Executive, Legislative, and Other General Government Support; and Waste Collection. WMSDs had the highest compensable claims rates.

Conclusions

Services is a large sector of the economy, and the substantial number, rate, and cost of occupational injuries within this sector should be addressed. Several Services Sector industry groups are at high risk for a variety of occupational injuries. Using a PI to rank industry groups based on their injury risk provides information with which to guide prevention efforts.

International survey of occupational health nurses' roles in multidisciplinary teamwork in occupational health services

Access to occupational health services for primary prevention and control of work-related injuries and illnesses by the global workforce is limited (World Health Organization [WHO], 2013). From the WHO survey of 121 (61%) participating countries, only one-third of the responding countries provided occupational health services to more than 30% of their workers (2013). How services are provided in these countries is dependent on legal requirements and regulations, population, workforce characteristics, and culture, as well as an understanding of the impact of workplace hazards and worker health needs. Around the world, many occupational health services are provided by occupational health nurses independently or in collaboration with other disciplines' professionals. These services may be health protection, health promotion, or both, and are designed to reduce health risks, support productivity, improve workers' quality of life, and be cost-effective. Rantanen (2004) stated that basic occupational health services must increase rather than decline, especially as work becomes more complex; workforces become more dynamic and mobile, creating new models of work-places; and jobs become more precarious and temporary. To better understand occupational health services provided by occupational health nurses globally and how decisions are made to provide these services, this study examined the scope of services provided by a sample of participating occupational health nurses from various countries.

The economic burden of disease by industry: Differences in quality-adjusted life years and associated costs

BACKGROUND

This study compares differences in quality-adjusted life expectancy across the eight original National Occupational Research Agenda (NORA) industry sectors.

METHODS

Data from the 1997 to 2012 National Health Interview Survey (NHIS) were used to estimate quality-adjusted life years (QALYs) for all workers and by NORA sector. Differences in QALYs were calculated and translated into economic values using estimates of the societal willingness-to-pay per QALY.

RESULTS

Mean QALYs across workers was 29.17 years. Among NORA sectors, wholesale, and retail trade workers had the highest average QALYs remaining (35.88), while mining workers had the lowest QALYs (31.4). The economic value of this difference ranges from $604,843 to $1,155,287 per worker depending on the societal willingness-to-pay per QALY.

CONCLUSION

The value of life lost within some industries is very high relative to others. Additional investments in occupational safety, benefits, and health promotion initiatives may reduce these losses, but experimental research is needed to assess the effectiveness of such programs.

Work related injuries in Washington State's Trucking Industry, by industry sector and occupation

BACKGROUND

The trucking industry continues to have some of the highest work-related injury and illness rates and costs of any industry in the United States. Until recently, little focus has been placed on addressing non-motor vehicle collision related injuries within the trucking industry. Drivers are exposed to multiple physical risk factors that contribute to occupational injuries in order to complete their job duties, such as loading/unloading freight, decoupling trailers, strapping down loads and ingress and egress from the cab and trailer. About one-fourth of all truck driver injuries in the United States are related to slips, trips, and falls near the truck.

PURPOSE

The purpose of this descriptive study is to report on recent injuries in the trucking industry in Washington State. Data are presented by occupation and industry sector, in order to better understand the magnitude of specific injuries in terms of time-loss days and workers' compensation costs.

METHODS

All accepted, compensable (time-loss) claims from 2005 to 2010 within the trucking industry in Washington State were reviewed. Counts, rates, median and quartile data are presented. Logistic regression models are presented to identify factors associated with more severe claims.

RESULTS

Non-traumatic musculoskeletal disorders of the neck, back and upper extremities are the most frequent injuries across all industry sectors and occupations in the trucking industry. Vehicle related claims had the highest median costs and time loss days and Courier and Messenger claims had the highest risk for higher time loss claims. Injuries varied substantially by sector and within sectors by occupation.

CONCLUSION

It is important to review work-related injuries within the trucking industry by sector and occupation in order to maximize limited resources for injury prevention within this important sector.

Establishing the value of occupational health nurses' contributions to worker health and safety: a pilot test of a user-friendly estimation tool

Occupational health nurses use their knowledge and skills to improve the health and safety of the working population; however, companies increasingly face budget constraints and may eliminate health and safety programs. Occupational health nurses must be prepared to document their services and outcomes, and use quantitative tools to demonstrate their value to employers. The aim of this project was to create and pilot test a quantitative tool for occupational health nurses to track their activities and potential cost savings for on-site occupational health nursing services. Tool developments included a pilot test in which semi-structured interviews with occupational health and safety leaders were conducted to identify currents issues and products used for estimating the value of occupational health nursing services. The outcome was the creation of a tool that estimates the economic value of occupational health nursing services. The feasibility and potential value of this tool is described.

A comparative analysis of occupational health and safety risk prevention practices in Sweden and Spain

INTRODUCTION

Scandinavian countries such as Sweden implemented the occupational health and safety (OHS) measures in the European Directive 89/391/EEC earlier than other European counties, including Spain. In fact, statistics on workplace accident rates reveal that between 2004 and 2009, there were considerably fewer accidents in Sweden than in Spain.

METHOD

The objective of the research described in this paper was to reduce workplace accidents and to improve OHS management in Spain by exploring the OHS practices in Sweden. For this purpose, an exploratory comparative study was conducted, which focused on the effectiveness of the EU directive in both countries. The study included a cross-sectional analysis of workplace accident rates and other contextual indicators in both national contexts. A case study of 14 Swedish and Spanish companies identified 14 differences in the preventive practices implemented. These differences were then assessed with a Delphi study to evaluate their contribution to the reduction of workplace accidents and their potential for improving health and safety management in Spain.

RESULTS

The results showed that there was agreement concerning 12 of the 14 practices. Finally, we discuss opportunities of improvement in Spanish companies so that they can make their risk management practices more effective.

PRACTICAL APPLICATIONS

The findings of this comparative study on the implementation of the European Directive 89/391/EEC in both Sweden and Spain have revealed health and safety managerial practices which, if properly implemented, could contribute to improved work conditions and accident statistics of Spanish companies. In particular, the results suggest that Spanish employers, safety managers, external prevention services, safety deputies and Labour Inspectorates should consider implementing streamlined internal preventive management, promoting the integration of prevention responsibilities to the chain of command, and preventing health and safety management from becoming a mere exchange of documents. The authors also encourage future research studies to use the methodology presented to compare and assess the European Directive 89/391/EEC implementation in other European countries.

An approach for optimal allocation of safety resources: using the knapsack problem to take aggregated cost-efficient preventive measures

On the basis of the combination of the well-known knapsack problem and a widely used risk management technique in organizations (that is, the risk matrix), an approach was developed to carry out a cost-benefits analysis to efficiently take prevention investment decisions. Using the knapsack problem as a model and combining it with a well-known technique to solve this problem, bundles of prevention measures are prioritized based on their costs and benefits within a predefined prevention budget. Those bundles showing the highest efficiencies, and within a given budget, are identified from a wide variety of possible alternatives. Hence, the approach allows for an optimal allocation of safety resources, does not require any highly specialized information, and can therefore easily be applied by any organization using the risk matrix as a risk ranking tool.

Aging, sex, and cost of medical treatment

OBJECTIVE

Association between medical cost from workplace injuries and aging and its effect modification by sex were examined.

METHODS

Medical costs reimbursed from workers' compensation between 2003 and 2009 were used. A multiple zero-truncated negative binomial regression predicted percent changes in medical cost. Cubic regression spline smoothers tested effect modification.

RESULTS

Reimbursed medical costs comprised 3452 claims. Medical costs increased with aging; however, the trends differ by sex. Medical cost increase after 10 years of age increase was 27% among men (95% CI = 17% to 38%) and was 15% among women (12% to 22%). Medical cost spent among the youngest women was higher than that for the oldest men. The ratio of cost between the oldest women and oldest men was double.

CONCLUSIONS

Prioritizing controls for injuries in hospitals should focus on women and aging workers.

Analysis of ethnic disparities in workers' compensation claims using data linkage

OBJECTIVE

The overall goal of this research project was to assess ethnic disparities in monetary compensation among construction workers injured on the job through the linkage of medical records and workers' compensation data.

METHODS

Probabilistic linkage of medical records with workers' compensation claim data.

RESULTS

In the final multivariable robust regression model, compensation was $5824 higher (P = 0.030; 95% confidence interval: 551 to 11,097) for white non-Hispanic workers than for other ethnic groups when controlling for injury severity, affected body region, type of injury, average weekly wage, weeks of temporary total disability, percent permanent partial disability, death, or attorney use.

CONCLUSIONS

The analysis indicates that white non-Hispanic construction workers are awarded higher monetary settlements despite the observation that for specific injuries the mean temporary total disability and permanent partial disability were equivalent to or lower than those in Hispanic and black construction workers.

A systems approach to accident causation in mining: an application of the HFACS method

This project aimed to provide a greater understanding of the systemic factors involved in mining accidents, and to examine those organisational and supervisory failures that are predictive of sub-standard performance at operator level. A sample of 263 significant mining incidents in Australia across 2007-2008 were analysed using the Human Factors Analysis and Classification System (HFACS). Two human factors specialists independently undertook the analysis. Incidents occurred more frequently in operations concerning the use of surface mobile equipment (38%) and working at heights (21%), however injury was more frequently associated with electrical operations and vehicles and machinery. Several HFACS categories appeared frequently: skill-based errors (64%) and violations (57%), issues with the physical environment (56%), and organisational processes (65%). Focussing on the overall system, several factors were found to predict the presence of failures in other parts of the system, including planned inappropriate operations and team resource management; inadequate supervision and team resource management; and organisational climate and inadequate supervision. It is recommended that these associations deserve greater attention in future attempts to develop accident countermeasures, although other significant associations should not be ignored. In accordance with findings from previous HFACS-based analyses of aviation and medical incidents, efforts to reduce the frequency of unsafe acts or operations should be directed to a few critical HFACS categories at the higher levels: organisational climate, planned inadequate operations, and inadequate supervision. While remedial strategies are proposed it is important that future efforts evaluate the utility of the measures proposed in studies of system safety.

Occupational health and safety surveillance and research using workers' compensation data

OBJECTIVE

Examine uses of US workers' compensation (WC) data for occupational safety and health purposes.

METHODS

This article is a summary of the proceedings from an invitational workshop held in September 2009 to discuss the use of WC data for occupational safety and health prevention purposes.

RESULTS

Workers' compensation data systems, although limited in many ways, contain information such as medical treatments, their costs and outcomes, and disability causes that are unavailable from national occupational surveillance sources.

CONCLUSIONS

Despite their limitations, WC records are collected in a manner consistent with many occupational health and safety surveillance needs. Reports are available on the use of WC data for surveillance and research purposes such as estimating the frequency, magnitude, severity, and cost of compensated injuries. Inconsistencies in WC data can limit generalization of research results.

Development of an indirect-cost calculation model suitable for workplace use

INTRODUCTION

Occupational Health and Safety (OHS) stakeholders rarely factor the cost of workplace accidents into prevention spending decisions. The lack of consideration of this key information is related to the fact that the scientific literature has failed to provide OHS stakeholders with a cost-calculation tool that is both sufficiently accurate and does not require a data-collection stage ill-suited to the time constraints of workplace decision-makers.

METHOD

This study reviews the recent literature to identify key elements that should foster the use of indirect-cost calculation methods by decision makers.

RESULTS

A "local" approach currently appears to be the best method for calculating indirect costs of workplace incidents or accidents in comparison to "bottom-up" or "top-down" approach. This paper discusses four criteria that this type of approach must satisfy to be compatible with the time constraints and accuracy demands of OHS stakeholders in organizations. In addition, four bases for the development of a new indirect cost estimation model are presented and discussed.

IMPACT ON INDUSTRY

this study provides bases and criteria to help the development of indirect-cost calculation models better suited to workplace use than those currently available.

Predictors and economic burden of serious workplace falls in health care

AIMS

To examine the demographic and workplace risk factors of serious falls and associated economic burden in Canadian health care workers.

METHODS

Fall injury data during 2005-2008 from a workplace health and safety surveillance system were linked with workers' compensation claims and payroll records. The costs for treatment and wage loss and days lost for accepted time-loss claims were calculated. Demographic and work-related factors were identified to distinguish the risk for more serious falls from less serious falls.

RESULTS

Nine hundred and thirty-eight fall injury claims were captured among 48 519 full-time equivalent workers. Workers >60 years, part time or employed in the long-term care sector sustained a higher proportion of serious falls (>70%). Over 75% of falls were serious for care aides, facility support service workers and community health workers. In the multivariate analysis, the risk of serious falls remained higher for workers in the long-term care sector [odds ratio (OR) 1.71; P < 0.05] compared with those in acute care and for care aides (OR 1.72; P < 0.05), facility support service workers (OR 2.58; P < 0.01) and community health workers (OR 3.61; P < 0.001) compared with registered nurses (RNs). The median number of days lost was higher for females, long-term care workers, licensed practical nurses and care aides. Females, long-term care workers, RNs, licensed practical nurses, care aides and maintenance workers had the most costly falls.

CONCLUSIONS

Reducing work-related serious fall injuries would be expected to bring about significant benefits in terms of reduced pain and suffering, improved workplace productivity, reduced absenteeism and reduced compensation costs.

Incidence and cost of nonfatal farm youth injury, United States, 2001-2006

The objective of this study was to estimate the annual incidence and cost of nonfatal farm youth injury in the United States for the period 2001-2006. The authors used 2001-2006 Childhood Agricultural Injury Survey data to estimate the annual incidence of farm youth nonfatal injury. To estimate the costs for injuries suffered by youth working/living on the farm, the number of injuries was multiplied by published unit costs by body part, nature of injury, and age group. The annual number of nonfatal injuries to youth (ages 0-19) on farms in 2001-2006 was 26,570. The annual cost of nonfatal farm youth injuries was $1 billion (in 2005 dollars), with 26% of costs related to working on the farm and 47% on beef cattle farms. Around 9.3% of the cost was medical costs, 37.2% work and household productivity loss, and 53.5% quality of life loss.

Occupational health assessment of chromite toxicity among Indian miners

Elevated concentration of hexavalent chromium pollution and contamination has contributed a major health hazard affecting more than 2 lakh mine workers and inhabitants residing in the Sukinda chromite mine of Odisha, India. Despite people suffering from several forms of ill health, physical and mental deformities, constant exposure to toxic wastes and chronic diseases as a result of chromite mining, there is a tragic gap in the availability of 'scientific' studies and data on the health hazards of mining in India. Occupational Safety and Health Administration, Odisha State Pollution Control Board and the Odisha Voluntary Health Association data were used to compile the possible occupational health hazards, hexavalent chromium exposure and diseases among Sukinda chromite mines workers. Studies were reviewed to determine the routes of exposure and possible mechanism of chromium induced carcinogenicity among the workers. Our studies suggest all forms of hexavalent chromium are regarded as carcinogenic to workers however the most important routes of occupational exposure to Cr (VI) are inhalation and dermal contact. This review article outlines the physical, chemical, biological and psychosocial occupational health hazards of chromite mining and associated metallurgical processes to monitor the mining environment as well as the miners exposed to these toxicants to foster a safe work environment. The authors anticipate that the outcome of this manuscript will have an impact on Indian chromite mining industry that will subsequently bring about improvements in work conditions, develop intervention experiments in occupational health and safety programs.

Occupational fatalities, injuries, illnesses, and related economic loss in the wholesale and retail trade sector

BACKGROUND

The wholesale and retail trade (WRT) sector employs over 21 million workers, or nearly 19% of the annual average employment in private industry. The perception is that workers in this sector are generally at low risk of occupational injury and death. These workers, however, are engaged in a wide range of demanding job activities and are exposed to a variety of hazards. Prior to this report, a comprehensive appraisal of the occupational fatal and nonfatal burdens affecting the retail and wholesale sectors was lacking. The focus of this review is to assess the overall occupational safety and health burden in WRT and to identify various subsectors that have high rates of burden from occupational causes. Ultimately, these findings should be useful for targeted intervention efforts.

METHODS

We reviewed Bureau of Labor Statistics (BLS), 2006 fatality, injury, and illness data for the WRT sector and provide comparisons between the WRT sector, its' subsectors, and private industry, which serves as a baseline. The BLS data provide both counts and standardized incidence rates for various exposures, events, and injury types for fatalities, injuries, and illnesses. In an effort to estimate the economic burden of these fatalities, injuries, and illnesses, a focused review of the literature was conducted.

RESULTS AND CONCLUSION

In 2006, WRT workers experienced 820,500 injuries/illnesses and 581 fatalities. The total case injury/illness rate for the retail sector was 4.9/100 FTE and for the wholesale sector 4.1/100 FTE. The WRT sector represents 15.5% of the private sector work population in 2006, yet accounts for 20.1% of nonfatal injuries and illnesses of the private sector. In 2003, the disparity was only 2% but increased to 3% in 2004 and 2005. Three WRT subsectors had injury/illness rates well above the national average: beer/wine/liquor (8.4/100); building materials/supplies (7.6/100); and grocery-related products (7.0/100). Occupational deaths with the highest rates were found in gasoline stations (9.8/100,000), convenience stores (6.1/100,000), and used car dealers (5.5/100,000). In terms of actual numbers, the category of food and beverage stores had 82 fatalities in 2006. Based on 1993 data, costs, both direct and indirect, in the WRT sector for fatal injuries were estimated to exceed $8.6 billion. The full economic loss to society and the family has not been adequately measured. Overexertion and contact with objects/equipment represent the top two events or exposures leading to injury or illness. Together they account for 57% of the events or exposures for nonfatal WRT injuries and illnesses. This sector is important because it is large and pervasive as a result, even a relatively small increase in injury rates and accompanying days away from work will have significant impact on working families and society.

Perceptions of occupational injury and illness costs by size of organization

BACKGROUND

Little is known about how organizations perceive and monitor occupational injury and illness costs.

AIMS

To explore perceptions of injury and illness costs, the extent to which organizations monitor their impact, attitudes towards this practice and views on using cost information in health and safety campaigns.

METHODS

Interviews were conducted with 212 representatives from 49 small- and medium-sized enterprises (SMEs) and 80 large organizations from a range of industry sectors.

RESULTS

Health and safety investments were driven by a range of factors, of which cost reduction was only one. Human costs were also considered important. Injuries were perceived to represent a substantial business cost by 10% of respondents from SMEs and 56% of those from large organizations. Most were uncertain about the financial impact of work-related illness. No organizations had attempted to monitor occupational illness costs. Injury costs had been assessed within 3 SMEs and 30 large organizations. Only 12% of SME representatives recognized the benefits of costing health and safety failures and around half were unreceptive to the use of cost information in health and safety promotions. Two-thirds of those from large organizations recognized some benefit in measuring costs, and over three-quarters welcomed the provision of industry-specific information.

CONCLUSIONS

Provision of information that focuses solely on the economic implications of occupational injury and illness may be of limited value and agencies involved in the promotion of health and safety should incorporate a range of information, taking into account the needs and concerns of different sectors.

Prioritizing prevention opportunities in the Washington State construction industry, 2003-2007

OBJECTIVE

This study compares construction industry groups in Washington State by injury severity and cost, and ranks industry groups according to potential for prevention.

METHODS

All Washington State workers' compensation compensable claims with date of injury between 2003 and 2007 were classified into North American Industrial Classification System (NAICS) industry groups. Claims were then aggregated by injury type and industry groups were ranked according to a prevention index (PI). The PI is the average of the rank orders of the claim count and the claim incidence rate. A lower PI indicates a higher need for prevention activities. The severity rate was calculated as the number of days of time loss per 10,000 full-time equivalents (FTEs).

RESULTS

For all injury types, construction industry groups occupy 7 of the top 15 PI ranks in Washington State. The severity rate among construction industry groups was twice that for non-construction groups for all injury types. Foundation, structure, and building exterior contractors (NAICS 2381) ranked highest in prevention potential and severity among construction industry groups for most common injury types including falls from elevation, fall on same level, struck by/against, and musculo-skeletal disorders of the neck, back, and upper extremity (WMSDs). Median claim costs by injury type were generally higher among construction industry groups.

CONCLUSIONS

The construction industry in Washington State has a high severity rate and potential for prevention. The methods used for characterizing these industry groups can be adapted for comparison within and between other industries and states.

IMPACT ON INDUSTRY

These data can be used by industry groups and employers to identify higher cost and higher severity injury types. Knowledge about the relative frequencies and costs associated with different injury types will help employers and construction industry associations make better informed decisions about where prevention efforts are most needed and may have the greatest impact. The results of this study can also be used by industry stakeholders to cooperatively focus on high cost and high severity injuries and explore best practices, interventions, and solutions as demonstrated by efforts to prevent musculoskeletal disorders in masonry (Entzel, Albers, & Welch, 2007). Initiating construction industry groups to focus on high cost and high severity injuries may also help prevent other types of injuries.

Costs by industry and diagnosis among musculoskeletal claims in a state workers compensation system: 1999-2004

BACKGROUND

Musculoskeletal disorders (MSDs) are a tremendous burden on industry in the United States. However, there is limited understanding of the unique issues relating to specific industry sectors, specifically the frequency and costs of different MSDs.

METHODS

Claim data from 1999 to 2004 from the Ohio Bureau of Workers' Compensation were analyzed as a function of industry sector (NAICS industry-sector categories) and anatomical region (ICD-9 codes).

RESULTS

Almost 50% of the claims were lumbar spine (26.9%) or hand/wrist (21.7%). The majority of claims were from manufacturing (25.1%) and service (32.8%) industries. The industries with the highest average costs per claim were transportation, warehouse, and utilities and construction. Across industries, the highest costs per claim were consistently for the lumbar spine, shoulder, and cervical spine body regions.

CONCLUSION

This study provides insight into the severity (i.e., medical and indemnity costs) of MSDs across multiple industries, providing data for prioritizing of resources for research and interventions.

Chemical plant innovative safety investments decision-support methodology

INTRODUCTION

This article examines the extent to which investing in safety during the creation of a new chemical installation proves profitable.

METHOD

The authors propose a management supporting cost-benefit model that identifies and evaluates investments in safety within a chemical company. This innovative model differentiates between serious accidents and less serious accidents, thus providing an authentic image of prevention-related costs and benefits. In classic cost-benefit analyses, which do not make such differentiations, only a rudimentary image of potential profitability resulting from investments in safety is obtained.

RESULTS

The resulting management conclusions that can be drawn from such classical analyses are of a very limited nature. The proposed model, however, is applied to a real case study and the proposed investments in safety at an appointed chemical installation are weighed against the estimated hypothetical benefits resulting from the preventive measures to be installed at the installation.

CONCLUSION

In the case-study carried out in question, it would appear that the proposed prevention investments are justified.

IMPACT ON INDUSTRY

Such an economic exercise may be very important to chemical corporations trying to (further) improve their safety investments.

Characteristics of national registries for occupational diseases: international development and validation of an audit tool (ODIT)

Background-

The aim of the study was to develop quality indicators that can be used for quality assessment of registries of occupational diseases in relation to preventive policy on a national level. The research questions were: 1. Which indicators determine the quality of national registries of occupational diseases with respect to their ability to provide appropriate information for preventive policy? 2. What are the criteria that can distinguish low quality from high quality?

Methods-

First, we performed a literature search to assess which output of registries can be considered appropriate for preventive policy and to develop a set of preliminary indicators and criteria. Second, final indicators and criteria were assessed and their content validity was tested in a Delphi study, for which experts from the 25 EU Member States were invited.

Results-

The literature search revealed two different types of information output to be appropriate for preventive policy: monitor and alert information. For the evaluation of the quality of the monitor and alert function we developed ten indicators and criteria. Sixteen of the twenty-five experts responded in the first round of the Delphi study, and eleven in the second round. Based on their comments, we assessed the final nine indicators: the completeness of the notification form, coverage of registration, guidelines or criteria for notification, education and training of reporting physicians, completeness of registration, statistical methods used, investigation of special cases, presentation of monitor information, and presentation of alert information. Except for the indicator "coverage of registration" for the alert function, all the indicators met the preset requirements of content validity.

Conclusion-

We have developed quality indicators and criteria to evaluate registries for occupational diseases on the ability to provide appropriate information for preventive policy on a national level. Together, these indicators form a tool which can be used for quality improvement of registries of occupational diseases.