Primary Prevention Initiative:Occupational Safety & Health

Objectives

• Upon completion of this module, learner will be able to:– Define levels of prevention– Describe how to select relevant topic, locate

data, and identify an appropriate intervention

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The Levels of Prevention

PRIMARYPrevention

SECONDARYPrevention

TERTIARYPrevention

Definition An intervention implemented before there is evidence of a disease or injury

An intervention implemented after a disease has begun, but before it is symptomatic.

An intervention implemented after a disease or injury is established

Intent Reduce or eliminate causative risk factors (risk reduction)

Early identification (through screening) and treatment

Prevent sequelae (stop bad things from getting worse)

Example Encourage exercise and healthy eating to prevent individuals from becoming overweight.

Check body mass index (BMI) at every well checkup to identify individuals who are overweight or obese.

Help obese individuals lose weight to prevent progression to more severe consequences.

Adapted from: Centers for Disease Control and Prevention. A Framework for Assessing the Effectiveness of Disease and Injury Prevention. MMWR. 1992; 41(RR-3); 001. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00016403.htm

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Primary Prevention Initiative (PPI)

• Established by Dr. Dreyzehner in 2012• Goal is to focus the Department’s energy

on primary prevention—eliminating risk factors for later problems

• Intent is for all TDH employees to engage in primary prevention efforts in their community

• Statewide Roll- out January, 2013

PPI Process– All counties participating in Primary

Prevention Initiatives– County forms PPI Team – PPI Team meets to determine focus areas– Counties may utilize Community Health

Assessments to determine priority topics– PPI Team submits PPI Proposal– PPI Team submits reports on each Activity– Process continues

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Team Work• Your county may have multiple teams working

on different community activities• Teams will spend 5% of their time working on

PPI– Approximately ½ day every other week

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PPI Teams

• Team members will be:– Catalysts– Encouragers– Resource providers– Data keepers/providers

• Team members are not sole workers– Teams will engage community partners to

accomplish activities

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PPI Teams

• Team size will vary– Teams of 3, 5, or 7 depending on health

department size• Team composition:

– Include community members– Teams should be multidisciplinary (clerical,

nursing, clinical, administrative)– Include Regional office staff

• i.e. Health Promotion Coordinator and/or Community Health Council Coordinator, county staff such as Health Educator, Health Care Provider, and administrative staff

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Topics for PPI Activities

– Tobacco – Obesity– Teen Pregnancy– Infant Mortality– Substance Use and Abuse– Immunizations– Suicide Prevention– Occupational Safety– Healthcare Associated Infections

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Selecting a Topic

• There are so many things you could choose to work on—but time and resources are limited!

• You will need to prioritize your efforts based on the specific need(s) in your community

• Needs (and therefore, projects) will likely vary across the State

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Selecting a Topic

• What can you use to help you prioritize?– Community Health Assessment Tools– County Health Council Priorities– Needs Assessments– Strategic Plans– Ranking/Report Card findings

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Locating Data

• Once you’ve selected the topic on which you plan to focus, you will need to locate data that is relevant to the topic

• Data can help you:– Confirm “suspicions” or “hunches”– Sharpen your focus on a particular aspect of

the topic– Identify baseline for measuring improvement

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Locating Data

• Some Potential Data Sources:– Birth/death certificates– Hospital Discharge data– Health Information Tennessee (HIT) website– Behavioral Risk Factor Surveillance System

(BRFSS)– Youth Risk Behavior Survey (YRBS)– Pregnancy Risk Assessment Monitoring

Survey (PRAMS)– Data from community health assessments

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Identifying An Intervention

• Once you’ve selected your topic and gathered appropriate data, it’s time to decide what you’re actually going to do

• There is no need to “re-invent the wheel”• Explore what others have done, what has

been tested, and what has been shown to work

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Identifying An Intervention

• Some Sources for Identifying an Intervention:– Guide to Community Preventive Service

• http://www.thecommunityguide.org/index.html

– Healthy People 2020, Community Interventions• http://www.healthypeople.gov/2020/topicsobjectives2020/ebr.

aspx?topicid=33#inter

– Institute of Medicine• http://www.iom.edu/~/media/Files/Report%20Files/2012/APO

P/APOP_insert.pdf

– Tennessee State Plan on Nutrition, Physical Activity and Obesity

• http://www.eatwellplaymoretn.org/assets/files/plan.pdf 15

PPI Proposal

• Once determined, submit PPI Proposal in PPI Proposal Survey Gizmo link:

http://www.surveygizmo.com/s3/1537642/PPI-Proposal

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PPI Proposal contains

• County • Topic• Objective• Activities• Team members• Primary contact• Community partners• Estimated Start Date• Estimated Completion Date

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PPI Activity Reporting

• As the PPI Team completes each activity, report in PPI Activity Reporting Survey Gizmo link:

• http://www.surveygizmo.com/s3/1458250/PPI-V3-0

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PPI Activity Reporting Contains

• County name• Division/Office• Topic• Objective• Activity description• Key Partners/Contributions• Start date of activity• Facilitating factors of success• Barriers encountered• Plans to overcome barriers• Unanticipated outcomes• Impact measures- numbers served• Stage of Change• Success Stories 19

ApplyingPrimary Prevention Principles to Occupational Safety and Health

Tennessee Occupational Safety & Health Administration (TOSHA)

Mission – committed to helping Tennesseans improve workplace safety and health. Some of these services include outreach, training and education, consultation and enforcement efforts.TOHSA: “Saving Lives, Preventing Injuries,

Protecting the Health of Workers”

Tennessee Data:2012 Occupational Fatality Investigations

Data Source: Tennessee OSHA

• Struck By 9 • Falls 7 (1 event/2 victims)• Crushed/Caught Between 5• Fire/Explosion/Chemical 3 (1 event/2victims)• Electrocution 2• Equip. Mechanical Failure 1• Cave in 1• Asphyxiation 1 • Drowning 1• Overturned Equipment 1• Workplace Violence 1 Total 32 34 Victims

Tennessee Data:2012 Fatality Investigations Sorted by Industry

Data Source: Tennessee OSHA

• Construction 12• General Industry 11• Service 05• Shipping 02• Retail 01• Public Sector 01• Total 32

TOSHA Believes

Institution of a safety and health management program in these

workplaces could have prevented these deaths and the approximately 95,000 injuries and illness that occur

to Tennessee workers each year.

Why Do We Want a Safe and Healthful Workplace?

• It’s the Law – – 29 CFR 1910 General Industry– 29 CFR 1926 Construction– 29 CFR 1928 Agriculture

• It’s the right thing to do– Every day in America, 13 people go to work and never come home. – Every year in America, nearly 4 million people suffer a workplace injury

from which some may never recover. – These are preventable tragedies that disable our workers, devastate our

families, and damage our economy.

• It’s Good Business– Medical Costs– Workers compensation insurance– Indemnity payments for an injured or ill worker

Source: Tennessee Occupational Safety and Health

IT’S GOOD BUSINESSHow Much Does it Cost?

COSTS:Tennessee State Workers’ Comp Insurance Annually

$950,000,000 (ALMOST ONE BILLION)

Tennessee Claims Per Year Over 100,000Tennessee Medical Claim Cost (Avg.) $30,000

How Do You Prevent Injuries and Illness and Save Money?

TOSHA’s four point safety and health management system

1. Management commitment and Employee involvement

2. Hazard analysis

3. Hazard prevention and control

4. Employee safety and health training

Proven Primary Prevention Strategies

Promote Workplace Health and Safety• Objective: Increase the number of local businesses who

implement a Four Point TOSHA Safety and Health Management System

• Activity: Support business efforts to initiate TOSHA Programs– Partner w/TOSHA to encourage businesses to implement

TOSHA Safety and Health Management System• https://www.osha.gov/Publications/smallbusiness/small-business.html

– Build community support (i.e. chamber of commerce, civic club, and other recognition) for change

– Implement local government policies to promote safe workplaces– Engage Management and Leadership

Proven Primary Prevention Strategies

Use Tennessee OSHA’s Consultation Service• Objective: Work with TOSHA Consultation staff to

inspect the workplace and identify safety and health hazards.

• Activity: Work with TOSHA to recruit one or more local small businesses (less than 250 employees or 500 employees corporate wide) to utilize the free, confidential service. A full report with recommendations will be issued. – No Direct Cost– No Penalties issued – Confidential – Effective

Proven Primary Prevention Strategies

Promote Tennessee Workplace Safety Recognition Awards to local businesses• Objective: Work with TOSHA to promote the Tennessee

Volunteer Protection Program (VPP) to local community businesses and government agencies

• Activity: Work with TOSHA to recruit one or more local businesses to pursue recognition for safety activities via TOSHA programs such as:– Volunteer STAR Award– SHARP Award– Governor’s Award– Commissioner’s Award

Additional Resources• Tennessee Occupational Safety and Health http://

www.state.tn.us/labor-wfd/tosha.html

• TOSHA Consultative Services http://www.state.tn.us/labor-wfd/tosha/toshcons.shtml

• TOSHA Training Serviceshttp://www.state.tn.us/labor-wfd/tosha/tande.shtml

• Federal OSHAwww.osha.gov

• Centers for Disease Controlwww.cdc.gov

• National Institute of Occupational Safety and Healthwww.cdc.gov/niosh

• Jim Flanagan, Star Program Manager (615) 741-5421 James.Flanagan@tn.gov

FOR TECHNICAL ASSISTANCE

• Rachel Heitmann, MSInjury Prevention/ Child Fatality Review/ Infant Mortality DirectorRachel.Heitmann@tn.gov(615) 741-0368

• Terry Love, MSInjury Prevention Program ManagerTerrence.Love@tn.gov(615) 532-7778