Report on the
To the end of June 1997
D E PA RT M E N T O F
OCCUPATIONAL SAFETY
& H E A LT H S E R V I C E
LABOUR
T E
TA R I
M A H I
Published by the
Occupational Safety & Health Service
Department of Labour
Wellington
New Zealand
July 1998
ISBN 0-477-03617-1
Cover artwork: Reproduced from Construction
Site, watercolour and pastel on paper by Lindsay
Crooks, 1990. Part of the series celebrating the
New Zealand worker, commissioned by Professor
Bill Glass.
2
Report on NODS
What is NODS?
N
ODS is an acronym for the Notifiable
Occupational Disease System, which was
established in March 1992.
It is a voluntary system, whereby occupational
physicians, specialists, general practitioners,
occupational health nurses, other health
professionals, and individuals can notify a
health-related condition which is suspected to
arise from work.
Report on NODS
3
Who administers NODS?
N
ODS is administered by the Occupational
Safety and Health Service of the
Department of Labour (known as OSH).
OSH is responsible for the operation and
enforcement of the Health and Safety in
Employment Act 1992. This is the principal
legislation for ensuring workplaces are safe and
healthy. It requires employers to:
• Provide and maintain a safe work
environment;
• Provide and maintain facilities for the safety
and health of employees at work;
• Ensure that machinery and equipment in the
place of work is designed, made, set up, and
maintained to be safe for employees;
• Ensure that employees are not exposed to
hazards in the course of their work; and
• Develop procedures for dealing with
emergencies that may arise while employees
are at work.
The Health and Safety in Employment Act
requires employers to notify OSH about workers
who suffer serious harm as a result of their work.
These notifications supplement voluntary
notifications made to NODS.
The Act also requires employees to accept
responsibility for their health and safety while at
work and make sure their actions do not harm
other workers.
4
Report on NODS
Why have a disease
notification system?
T
he Notifiable Occupational Disease System
has several objectives:
• It enables OSH to become aware of workrelated health problems. In this way, the sick
worker acts as an indicator of a sick
workplace.
• At the national level, it assists OSH to plan
and implement health promotional and
intervention strategies.
• Also at the national level, it allows OSH to
monitor trends in occupational disease
patterns. In time this will permit an evaluation
of the effectiveness of promotional and
intervention strategies.
• It raises awareness among health professionals
about an individual’s occupation being an
important determinant of disease.
• It assists workers and managers to recognise
more clearly harmful or dangerous work
situations or work practices.
• It provides a database for the development of
applied research.
Report on NODS
5
How does NODS work?
T
he NODS process involves the following
four stages:
Notification of a possible work-related
condition.
Investigation of the individual worker, their
work and their workplace by the health and
safety team of the local OSH branch.
Validation of the notification by departmental
medical practitioners, who can request further
assistance from specialist medical panels.
Entry of the confirmed cases on the NODS
database.
Notification
A notification comes either directly to the NODS
registrar on a standard notification form, or to
the OSH branch by other means. The NODS
registrar, on receipt of the notification, forwards
a copy to the departmental medical practitioner
in the appropriate OSH branch, who then directs
the investigatory procedure.
OSH recognises that general practitioners are
increasingly inundated with paper work. In
order to minimise the workload, the notification
card has been designed so that the practice nurse
can enter the individual’s personal information;
the doctor simply records the diagnosis.
6
Report on NODS
Phone notifications are also accepted from
doctors. These should be made to the local OSH
branch.
Investigation
A team approach to the investigation of
occupational disease, and the consequent
intervention in the workplace, is now practical
because OSH is the primary authority responsible
for health and safety at work. Investigating teams
may include: a departmental medical
practitioner, an occupational health nurse, an
industrial hygienist, an accident prevention
consultant, and health and safety inspectors.
The first stage in an investigation is usually
carried out by an occupational health nurse, who
could be assisted by the industrial hygienist or
one of the inspectors. Once the investigatory
process has been completed (and on occasions
this may require other medical specialist input),
the details are referred to the departmental
medical practitioner.
Validation
The departmental medical practitioner validates
the notification, which is sent to the registrar. If,
on completion of the investigation, the
departmental medical practitioner still has some
concerns about diagnosis or causation, specialist
panels have been established to which the case
can be referred. These are listed in Appendix 1.
Report on NODS
7
Validation is carried out to ensure that, as far as
possible, only cases with well-established
causation are included in the database. This
means that the register will contain good-quality
material for research and statistical purposes.
Where a case is not accepted for the register, it
will usually mean that another cause has been
established.
There will always be borderline cases where there
is some doubt. Such cases, even if not accepted
for the database, will still have the benefit of
workplace inspections and workplace
improvements where necessary.
A decision not to accept a case for the register
does not imply rejection of an individual’s claim
for accident compensation, which has different
criteria for acceptance.
Information recorded on the register regarding an
individual’s case is stored under strict
confidentiality. Personal information is not
supplied to ACC or any other organisation
without the individual’s signed consent to do so.
Intervention
It is important to emphasise that notification is
an indicator of a workplace hazard. A “sick”
worker alerts OSH to the existence of a “sick”
workplace. Intervention with effect must be the
ultimate end point of the process of notification
in order to prevent other workers from suffering
8
Report on NODS
the same consequences resulting from these work
circumstances. The investigative procedure is
illustrated in the diagram below.
Notifiable Occupational
Disease System
Notification made by
GP, occupational health
nurse,inspector or
individual.
Workplace and individual
investigated.
Notification received by
CNS, and recorded on
database.
Notification referred to
branch for investigation.
Local departmental medical
practitioner assesses the validity of
the notification.
Notifier and
individual informed
of DMP's conclusions
and
recommendations
and actions taken
by OSH.
DMP/ panel's
conclusions sent to
CNS and recorded
on NODS database.
DMP's conclusions sent
to specialist panel for
consideration.
Individual and
notifier (if
appropriate)
informed of
panel's conclusions
and
recommendations.
Report on NODS
9
Notifiable conditions
The most common and most important diseases
arising from occupation are listed in Table 1
below, together with the number of notifications
received since the inception of NODS in March
1992. The 1992/93 year includes notifications
made March 1992 through to 30 June 1993.
Subsequent years cover 1 July to 30 June.
Table 2 (facing page) classifies confirmed cases
according to ISCO88 two-digit classification and
notification type.
Table 1: Notifications received March 1992 to June 1997
Disease category
1992/93 1993/94 1994/95 1995/96 1996/97
Asbestos-related disease
383
103
132
67
71
756
39
60
97
81
67
344
Occupational asthma
Total
Other occupational respiratory
disease
Occupational disease due to
chemical exposure
7
11
34
31
24
107
71
89
115
94
91
460
Chronic solvent-induced
neurotoxicity
38
98
63
72
42
313
Occupational cancer
1
1
3
2
4
11
28
41
49
61
45
224
103
216
575
612
597
2103
Occupational overuse syndrome/
osteoarthritis
25
263
760
828
826
2702
Occupational skin disease
11
43
91
106
36
287
706
925
1919
1954
1803
7307
Occupational illness due to infection
Occupational noise-induced
hearing loss
Total
10
Report on NODS
Report
NODS
Report
onon
NODS
11
11
82
83
91
93
81
74
73
72
52
61, 92
71
41
42
51
31
23, 33
24, 34
Code
12,11, 13
21
22, 32
Description
Solvents Chemical
Managers, legislators and senior officials
2
Physics/math/engineering professionals
Health professionals (doctors, nurses, vets,
pharmacists, lab technicians etc.)
40
Teachers and teaching associate professionals
Other professionals (lawyers, accountants, police,
musicians, journalists)
Physical and engineering science
associate professionals
1
3
Office clerks
1
3
Customer service clerks
1
Service workers (cooks, hairdressers, firefighters,
home care workers, undertakers)
Salespeople, models and demonstrators
Agriculture and fisheries workers
14
Building and extraction trade (carpenters, plumbers,
painters, spraypainters)
25
18
Metal, machinery (welders, mechanics, tool makers,
fitters, blacksmiths)
24
Precision handicraft workers (jewellers, potters,
glass-makers, wood turners, printers)
9
2
Other craft and related trade workers (butchers,
bakers, cabinet makers, tailors, upholsters, shoemakers) 4
9
Stationary plant and related operators (power plant
operators, chemical plant operators,
wood processing operators)
2
7
Machine operators and assemblers
2
15
Drivers and mobile plant operators
1
Sales and services elementary occupations
3
2
Mining and construction labourers
2
9
Retired
Total
51
148
10
232
85
55
93
27
11
68
54
853
83
9
30
33
16
2
79
7
575
10
83
1
28
4
60
116
17
4
3
2
23
27
20
4
13
3
1491
10
102
7
29
42
106
24
16
21
16
13
29
23
578
213
169
24
19
Respiratory OOS
5
36
25
14
10
3
NIHL
35
38
Table 2: Confirmed NODS cases for the period 1 March 1992 to 30 June 1997
176
7
23
1
9
19
25
6
10
22
18
1
6
4
3
3
3
8
3
118
2
2
1
5
51
1
1
49
3
1
0
2
111
270
54
57
224
61
3412
288
50
250
404
63
18
168
78
610
224
197
97
28
Dermatitis Infections Total
3
81
2
79
Commentary
Asbestos-related disease
There have been 554 asbestos-related disease
cases confirmed by the Asbestos Medical Panel
since the register’s inception in 1992.
The cases fall into the following categories:
•
•
•
•
Mesothelioma: 94 cases.
Asbestosis: 118 cases.
Lung cancer: 49 cases.
Pleural abnormalities: 293 cases (this category
includes: pleural plaques; pleural thickening;
chronic fibrosing pleuritis; pleural effusions,
but does not include pleural disease occurring
together with mesothelioma, lung cancer or
asbestosis).
The cases are predominantly male, making up
537 (97%) of the cases. Females do, however,
account for 10% of the mesothelioma cases.
A gradual increase in mesothelioma cases has
occurred throughout this decade. Lung cancer is
under-notified because of the confounder
cigarette smoking, and pleural disease is
increasing.
Occupational asthma
There have been 344 suspected cases of
occupational asthma notified since NODS was
established in 1992. Of these cases, 94 have been
confirmed as occupational asthma.
12
Report on NODS
The causative agents and occupations involved in
the 94 confirmed cases are shown in Table 3
below.
Table 3: Occupational asthma: causative agents and occupations
Causative agent
Cases
Organic materials
Animal proteins
16
7
Cereal dusts
Wood dusts
4
5
Occupations
Poultry worker, confectionary process worker,
seafood processor
Bakers
Boat builders, carpenters
Chemicals
38
Aldehydes
5
Epoxy resins
5
Isocyanates
22
Chlorine-based cleaners
Organophosphate
Ozone
3
1
2
Boat builder, radiographers, medical technician,
medical manager.
Painter, metal finisher, process worker,
boatbuilder.
Spray painters, painters, process workers, boat
builders, carpenter, foundary worker, technicians,
floor sander.
Dairy process workers
Cleaner
Moulding room assistant, office manager
Metals
Aluminium
Welding fumes
22
16
6
Aluminium smelter workers
Engineers, fitter welders, mechanic.
Miscellaneous
Acrylates
Colophony containing solders
Dibutyl phthalate
PVC, polypropylene, fume
Polyurethane foam and fumes
Triglycidylisocyanurate
Unrecognised
18
1
4
1
3
2
1
7
Lab technician
Electrical process workers
Printer
Factory manager, baker
Foam manufacturer, sheet metal worker.
Powder coating process worker
Dairy process technician, assembly process
worker, spray painter, oven cleaners
Doctors notifying to the scheme seem aware of
the relationship between isocyanate exposure in
the painting, foam and construction industries
and the subsequent development of asthma.
Report on NODS
13
The scheme continues to reveal cases of
occupational asthma arising from causes that are
recognised in the medical literature but are not
well-established in the public or medical
professions’s awareness.
Two cases of lung disease (occupational asthma
and extrinsic allergic alveolitis) have been
attributed to exposure to organic dusts (peat
moss and bark dust). These conditions arose
from bacterial and fungal contamination of the
organic material.
The extrinsic allergic alveolitis (EAA) patient was
sufficiently ill to require a period in intensive
care. The employer of the occupational asthma
case failed to take the diagnosis provided by the
employee’s general practitioner seriously and
made no investigations of the worksite or of the
employee. They were prosecuted and convicted
under section 10 of the Health and Safety in
Employment Act 1992 for failing to monitor the
employee’s health status, a precedent-setting
prosecution under this legislation.
The hazard was controlled in the EAA case by
substituting sand for the peat moss and bark
product and the employee stayed at work. The
occupational asthma patient had to change jobs
to avoid exposure, elimination not being possible
and isolation and minimisation being
impracticable.
14
Report on NODS
Through its comprehensive respiratory
surveillance programme, the Tiwai Point
aluminium smelter identifies and notifies its cases
of pot room asthma. The incidence of this
condition seems comparable to overseas smelter
experience but because of the paucity of
notifications from other industries, “potroom
asthma” achieves an undue prominence.
Other “classical” cases of occupational asthma
(e.g. veterinarian and laboratory staff dealing
with animals; carpenters, cabinet makers and
joiners exposed to wood dust) are poorly
reported. It is the Occupational Asthma Panel’s
view that this represents a failure of notification
rather than an absence of these cases.
The key to making an accurate diagnosis of
occupational asthma remains based on:
• A thorough history including an occupational
and exposure history. Questioning about
symptoms should focus on the relationship of
symptoms to work exposures.
• Carrying out peak flow measurements both at
work and away from work. The Asthma Panel
recommends recording the best of the three
blows taken four times per 24 hours (before
shift, in the middle of shift, after shift and on
retiring) when the patient is off medication
and at a time that they are both at work and
away from work.
Report on NODS
15
OSH officers are available to help elucidate these
problems if doctors wish.
Occupational disease from chemical
exposure
Chemical poisonings, both traditional and new,
continue to be notified to OSH — indicating that
the New Zealand workplace remains a hazardous
place in which to work.
Table 4: Main categories of chemical notifications
Chemicals in hospital x-ray and
photographic departments
47
Chemicals in agriculture,
horticulture and silviculture
14
Chemical fumes
20
Metal fumes
10
Lead
41
Mercury
4
Solvents
10
Cadmium
1
Arsenic
2
Others
30
Hospital x-ray and photographic fumes
Glutaraldehyde and other chemicals used in this
process continue to be notified as a cause of
symptoms to workers engaged in these activities.
In some cases, the illnesses are the result of longterm exposure under conditions which have since
been corrected. Nevertheless, work circumstances
16
Report on NODS
still require attention, and organisations engaged
in these processes should be familiar with two
publications:
• The Safe Occupational Use of Glutaraldehyde
in the Health Industries. OSH, 1992.
• Radiographic Film Processing Procedures —
Guidance Notes for the Provision of a Safe
Work Environment and Safe Work Practice for
Radiographers and Darkroom Technicians.
ACC, 1986.
Other chemical fumes
Poisonings have been notified to OSH following
exposure to ammonia, phosgene, isocyanates,
chlorine, hydrogen sulphide, methylene chloride,
formaldehyde and styrene.
Metal fumes
Fumes from welding (zinc and lead) and foundry
casting processes were reported. Metal fume
fever, usually as a result of cutting or welding
galvanised iron, presents as a ‘flu-like illness
several hours after the work is over. The worker
recovers in 24-36 hours, and could contract the
illness again later in the working week if
re-exposed. Repeated exposure to mixed metal
fumes (zinc, copper, manganese, aluminium) or
intense exposure as the result of overtime can
lead to a pneumonitis, and on occasions, fatigue
becomes a feature of the illness together with
mood and memory impairment.
Report on NODS
17
Lead and mercury
These two “ancient” metals, as they have been
referred to, continue to cause illness. The two
major occupations associated with lead poisoning
were paint removal from houses containing leadbased paints, and radiator repair and motor
reconditioning activities. Readers are referred to
two useful publications on lead poisoning:
• Guidelines for the Management of Lead-based
Paint. OSH/Public Health Commission, 1995.
• Guidelines for the Medical Surveillance of
Lead Workers. OSH, 1994.
Chronic solvent-induced neurotoxicity
Between 24 February 1993 and 10 April 1997,
the panel considered and made a decision on 193
cases. Of these, 76 (39%) were classified as
“verified”, 79 (41%) as “not verified” and 38
(20%) as “unproven”.
Table 5 (facing page) shows the reasons for cases
being classified as “not verified” or “unproven”.
The majority of verified cases were in males (74/
76). Age ranged from 22 years to 57 years, with
mean age 39 years. The majority (60/67) were
Europeans, with only four Maori (about half the
number expected for their proportion in the
workforce) and three Pacific Islanders (the
number expected for their proportion in the
workforce). Length of exposure for the largely
irreversible type 2 neurotoxicity ranged from 8
18
Report on NODS
Table 5: Classification of cases
Verified
Type 1 neurotoxicity
14
Type 2 neurotoxicity
62
Type 3 neurotoxicity
0
Exposure insufficient
Symptoms not typical
Neuropsychological
assessment normal
Confounding factors present:
alcohol and/or drug abuse
head injury
alcohol and/or drug abuse + head injury
cerebrovascular disease
other neurological disease
Data inadequate to make a decision
Totals
( %)
76
(39.4%)
Not verified
Unproved
39
7
1
21
1
3
8
3
1
1
3
2
26
79
(40.9%)
38
(19.7%)
1
years to 36 years, with a mean exposure time of
19.8 years. Twenty-nine (47%) of the type 2
cases were classified by the panel as “mild”, and
33 (53%) as moderate. There were no cases
classified as severe. There was a general trend of
increasing severity with length of exposure, with
48% of those exposed for less than 20 years
being classified as moderate, and 59% of those
with over 20 years’ exposure being classified as
moderate.
The most frequent occupation was that of spray
painters (25 (39%)), followed by printers (10
Report on NODS
19
(16%)) and boatbuilders (6 (9%)), as shown in
Table 6 below. Most were exposed to mixtures of
solvents, with mixtures of aliphatic and aromatic
hydrocarbons predominating.
Drycleaning workers were largely exposed to a
single solvent, the chlorinated hydrocarbon
perchloroethylene. The school caretaker was
exposed only to the graffiti-removal agent
dichlorobenzene, and the coating applicator to
the chlorinated hydrocarbon trichloroethylene.
Some of the cases on the panel’s register have
now been free from solvent exposure for up to
four years. Overseas literature indicates that
Table 6: Verified type 2 cases: occupation and solvent type(s)
Occupation
Spraypainter
Printer
Boatbuilder
Paint worker
Aircraft maintenance
Drycleaner
Furniture finisher
House painter
Shoe repair
Vinyl layer
Signwriter
Caretaker
Chemical worker
Ink technician
Panelbeater
Screen printer
Trimmer
20
Report on NODS
No.
25
10
6
4
2
2
2
2
2
2
1
1
1
1
1
1
1
%)
(39)
(16)
(9)
(6)
(3)
(3)
(3)
(3)
(3)
(3)
(2)
(2)
(2)
(2)
(2)
(2)
(2)
Solvent type(s)
aliphatics, aromatics
aliphatics, aromatics, ketones
aliphatics, aromatics
aliphatics, aromatics, ketones
aliphatics, chlorinated hydrocarbons, ketones
chlorinated hydrocarbons
aliphatics, aromatics, ketones
aliphatics, aromatics
aromatics, ketones
aliphatics, aromatics, ketones
aliphatics, aromatics
chlorinated hydrocarbons
aromatics, ketones
aliphatics, aromatics, ketones, acetates, alcohols
aliphatics, aromatics
aromatics, ketones
aliphatics, aromatics
about 50% of cases show some signs of recovery
from the long-term effects of solvents, and that
this may occur for periods of several years after
ceasing exposure. The panel is presently carrying
out research on cases registered as being
validated to determine the extent of recovery
experienced under New Zealand conditions.
Occupational cancer
Among the 11 cases of queried occupational
cancer recorded in the NODS database, only one
could be confirmed. This was a nasal cancer in a
worker exposed to chemicals in the timber
treatment industry. Clearly, notifications of workrelated cancers are sparse. Whether this is due to
the non-occurrence of such cancers in the New
Zealand workplace, or to the failure to determine
causation, is not known. Reference to the report
of the New Zealand Cancer Register reveals that
details of occupation are not published in their
annual reports.
Occupational infectious diseases
The most common condition notified was
leptospirosis. It occurred to workers in such
occupations as farmers, meatworkers and meat
inspectors. One case of interest occurred to a
septic tank cleaner who visited a pig farm to
clean the septic tank. Another case of L Canicola
occurred to an individual who cared for a large
number of stray dogs.
Report on NODS
21
Although it is believed that New Zealand is free
of brucellosis, five cases have been notified.
Campylobacter and salmonellosis have occurred
to farm workers, although one case was notified
in a truck driver who collected some carpets
which had been contaminated by sewage.
Orf continues to occur to meat workers and
farmers.
Occupational noise-induced hearing loss
The OSH definition of occupational noiseinduced hearing loss (NIHL) is based on:
• A history of exposure to noise at work;
• A symmetrical hearing loss unless there is a
history of unilateral noise exposure;
• A hearing loss at 4000 Hz of at least 30 dB
which is at least 15 dB worse than the loss at
2000 Hz; and
• A recovery at frequencies above 6000 Hz (this
is not a constant finding).
1248 cases have been validated, of which 97%
were male. The average age at notification was
50 years, with little difference between males and
females. Notifications per 1000 population
according to region varied from 0.02 to 0.64.
This most likely reflects the enthusiasm of the
local health professionals.
Occupational overuse syndrome
This condition, known variously as OOS, RSI or
22
Report on NODS
cumulative trauma disorder (CTD), continues to
be widely notified among office workers, freezing
workers and assembly workers. The use of the
term OOS is being discouraged as a diagnosis as
it blurs the distinction between well-defined and
well-recognised conditions and those conditions
which are typified by general and widespread
pain.
Table 7 below is a classification using ICD-10
codes, and the lists in the table are not
exhaustive. Controversy surrounds local and
general chronic pain disorders known as
myofascial pain syndrome (MPS) and
fibromyalgia syndrome (FMS). Each case needs
to be reviewed on its merits to determine the role
of work as a causative agent.
Table 7: Occupational overuse syndrome
Localized
conditions
Nerve compression
syndromes
Trigger finger M65.3
Carpal tunnel syndrome G56.0
de Quervains tenosynovitis Thoracic outlet syndrome G54.0
M65.4
Ulnar nerve compression G56.2
Bursitis M70.5
Radial nerve compression G56.3
Palmar fascial fibromatosis
M72.0
Plantar fasciitis M72.2
Rotator cuff syndrome
M75.1
Medial & lateral epicondilitis
M77.0
M77.1
Regional or general pain
syndromes
Fibromyalgia M79.0
Myofascial pain syndrome M79.0
Reflex sympathetic dystrophy M89.0
Regional pain syndrome
Chronic pain syndrome
Report on NODS
23
Case studies
Lead poisoning with unusual features
A 41-year-old man was a quality controller for a
circuit board manufacturer, a job he had held for
eight years. The process involved an automatic
soldering unit, but if the work was not satisfactory
he redid it by hand. He used a lead-based solder.
Over the 12 months before notification, he had
been noting memory impairment, fatigue and
intermittent vomiting. Over the last few years he
had had intermittent depression, for which he had
been on Prozac. His GP, as part of a medical
workup, found elevated blood lead at 2.8µmol/l
whole blood. Enquiry by OSH showed that he was
in the habit of chewing solder at work, and that
he also did soldering at home because of his hobby
of fixing radios. He was immediately removed from
all soldering work.
One month later his blood lead level was still
elevated at 2.6µmol/l whole blood, in spite of
apparently no ongoing exposure to lead. A month
later he was again seen by the OSH departmental
medical practitioner. His blood lead was
dangerously raised at 6.1µmol/l whole blood. He
had neurological signs. He was admitted to hospital
for chelation.
His psychiatric state had caused him to continue
to chew solder at home. This case points to the
need to look beyond the obvious workplace factors.
24
Report on NODS
OOS - Upper limb pain in librarian
A library worker was notified to OSH with pain
in her left forearm, of several months’ duration.
More recently, the pain had begun to involve the
right elbow. It did not go away over weekends,
and it made many domestic (and work) tasks
difficult. She had been referred to a
physiotherapist by her GP but could not afford
to pay and so did not attend. She had had no
treatments and was still working.
On examination she was found to have bilateral
lateral epicondylitis, with the left arm being
much more affected than the right. She was lefthanded. Other workers in the library had similar
problems, which were attributed to shelving
books, or pushing the trolleys of books.
One of the main tasks was working at the issues
desk, where the librarian would have to run the
book over the desensitiser set into the desk. This
meant that the book was grasped with the palm
of the hand facing downwards, and the wrist
extensors were carrying the weight. This
operation was repeated hundreds of times a day,
often with very heavy books.
By comparison, when shelving books a twohanded technique was usually used for the
heavier books, and was thus reliant on the wrist
extensors for carrying the load.
This kind of desensitiser, where the book needs
Report on NODS
25
to be upended on to its spine, frequently causes
problems of this type. The library was
encouraged to install an alternative desensitiser
where the book could be slid flat across the desk.
In addition, stretching exercises were discussed
to help alleviate the symptoms of epicondylitis.
Herbicide poisoning in a gorse sprayer
A gorse sprayer’s job was to pump the
concentrate from 44-gallon drums of 24-D and
2.45-T into two four-gallon buckets. He then
carried the buckets across a field to a helicopter
and tipped them into a hopper. He wore no
protective equipment apart from gloves which,
like his clothes, soon became soaked. He used
two sets of clothes a day: their smell was such his
wife soaked them outside before washing them.
An accident occurred as he was filling the
helicopter hopper. He was midway through
tipping in the second bucket when there was a
high-pressure blowback through the system and
the entire contents of the hopper blew into his
face, eyes, mouth, chest and arms. No water had
been added at this stage to dilute the concentrate.
He suffered the acute effects of herbicide
poisoning, with burning skin, eyes and mouth; he
was also dizzy and could not keep his balance.
He had acute diarrhoea and vomiting and severe
abdominal pain. The acute symptoms settled in
two weeks, but he was plagued thereafter with
26
Report on NODS
periodic bouts of abdominal pain, irritability and
fatigue.
His ACC claim was settled some 16 years later.
Organophosphate poisoning in a farmer
A 64-year-old widow took on the management of
a 400-acre sheep and cattle farm when her
husband died.
At the beginning of 1996, there was an outbreak
of fly strike. She purchased “Maggo”, a mixture
of an organophosphate and dichlorobenzene. She
mixed the concentrate with water and used some
four litres of concentrate. The sheep were sprayed
with the mix in the race or, on occasions, on the
farm. Treatment was continued daily for about
one hour over a period of four to five months.
She frequently completed the spraying process
with her clothes and skin soaked with “Maggo”.
Some two months after commencing the spray
programme, and within a few hours of last
spraying, she developed what she thought was
the ”flu”. Her head was heavy, her nose and
mouth dry, her vision was blurry, and she had
ringing in the ears and chest tightness. She
became fatigued, had a “racing pulse” and in
time noticed some short-term memory and
concentration difficulties.
One year after first exposure and seven months
after last exposure, her symptoms had resolved.
Report on NODS
27
Mushroom worker’s lung
A 56-year-old male presented with a two-month
history of shortness of breath on effort and
persistent nonproductive cough. He had been
unemployed for two years until beginning work
at a mushroom factory in January 1997, from
which he was discharged at the end of March.
His work involved digging dusty effluent from a
crusher inside a warehouse-sized enclosure and
driving a forklift containing racks of compost for
spawning.
His respiratory symptoms appeared within two
weeks of commencing work, and by the time he
was seen, two weeks after leaving his
employment, he noticed improvement.
He was a smoker of 20 cigarettes a day (35 pack
year history) and had no significant past history.
Clinically his chest was overinflated and hyperresonant with a few bibasal crackles. The chest
radiograph showed bilateral nodular pulmonary
infiltration.
A diagnosis was made of mushroom worker’s
lung (extrinsic allergic alveolitis) and smoker’s
COPD. He was treated with bronchodilators,
inhaled steroids and advised to quit smoking. By
the follow-up examination two months later, he
had reduced his smoking to two cigarettes a day;
his chest was now clear and chest x-ray normal.
Comment: Mushroom worker’s lung is one of the
28
Report on NODS
pulmonary hyper-sensitivity conditions which
was first described in mushroom farmers in
Puerto Rico in 1959.
Respiratory symptoms have been identified
following all phases of picking, sorting and
disposal of the compost. Typical symptoms
include coughing and shortness of breath, and
clinical signs are few, with only occasional
inspiratory crackles. Clubbing is rare. The
laboratory abnormalities include a restrictive
ventilatory defect (occasionally obstructive),
impaired gas transfer and precipitating
antibodies to a variety of thermophilic
actinomyces. The radiological abnormality
consists of bilateral miliary confluent but illdefined opacities in the mid and lower zones.
Obstructive airways disease in an eel
processor using ammonia
A 23-year-old male began work in 1996 in a fish
processing factory where eels were deslimed using
ammonia. The ammonia was used in an open
container with inadequate ventilation. Within
three weeks of beginning this job, he developed
shortness of breath, a tight, wheezy chest and a
productive cough. His symptoms improved on
days off work. His peak flows dropped from 500
l/min to 200 l/min in the course of a working
day. Since stopping work, his symptoms have
improved and his lung function has returned to
normal.
Report on NODS
29
He was “chesty” as a child but never diagnosed
as an asthmatic. He is a smoker, 20 cigarettes a
day. There is a family history of alpha 1
antitrysin deficiency. He gets seasonal hay fever.
Hearing loss in farmers
The audiogram shown below is that of a 58-yearold farmer who had driven a tractor for 28 years.
A recent OSH branch study in Nelson has
confirmed the widespread nature of noiseinduced hearing loss among farmers.
30
Report on NODS
Appendix 1: Current
NODS panels and
membership
Asbestos and Mineral Dust Medical
Panel
Professor Bill Glass (convenor)
Dr Robert Armstrong
Dr David Fishwick (overseas consultant)
Dr David Jones
Chronic Solvent Neurotoxicity Panel
Dr Evan Dryson (convenor)
Associate Professor Jenni Ogden
Associate Professor Neil Anderson
Asthma Panel
Dr Chris Walls (convenor)
Dr Margaret Wilshire
Dr Julian Crane
Dr Colin Wong
Dr John Gillies
Chemical Toxicity Panel
Professor Bill Glass (convenor)
Dr Andrew Macfie
Dr Michael Beasley
Mr Errol Hodgkinson
Report on NODS
31
Appendix 2: Other OSH
publications
Below is a selected list of occupational health
publications available from OSH. A fuller list is
available from any branch office: also visit our
web site: http:// www.osh.dol.govt.nz
Asbestos Exposure and Disease: Notes for Medical
Practitioners
Back in Care: Preventing Musculoskeletal Injuries
in Staff in Hospitals and Residential Care
Facilities
Chronic Organic Solvent Neurotoxicity:
Diagnostic Criteria
Guidelines for the Medical Surveillance of Lead
Workers
Manual Handling — Guidelines for the Workplace
Occupational Overuse Syndrome — Checklists for
the Evaluation of Work
Occupational Overuse Syndrome — Guidelines for
Prevention and Management
Occupational Overuse Syndrome — Treatment
and Rehabilitation: A Practitioner’s Guide
Practical Guidelines for the Safe Use of Organic
Solvents
Safe Occupational Use of Glutaraldehyde in the
Health Industries
The Pocket Ergonomist — Clerical/keyboard and
retail/industry versions
32
Report on NODS
Appendix 3: Departmental
medical practitioners
The following departmental medical practitioners
can be contacted through OSH branch offices
Practitioner
OSH branch office
Dr Evan Dryson
Dr Chris Walls
Dr Martin Robb
Dr Ian Bisset
Dr Paul Veitch
Dr Lissa Judd
Professor Bill Glass
Dr David McBride
Dr Gordon Hancock
Dr Greg Beacham
Dr John Gillies
Dr Jeff Brownless
Dr Jonathon Morton
Penrose
Manukau
Hamilton
Rotorua
New Plymouth
Lower Hutt
Nelson
Dunedin
Invercargill
Napier
Christchurch
Tauranga
Palmerston North
Report on NODS
33
Appendix 4: Departmental
occupational hygienists
and other specialist staff
The following departmental occupational
hygienists and specialist staff can be contacted
through OSH branch offices.
34
Senior scientists
Errol Hodgkinson
Mel Tyson
Mark Fielder (Forestry)
OSH branch office
Christchurch South
Lower Hutt
Rotorua
Occupational hygienists
Garry Trotman
David Appleby
Nick Matsas
Jim Sutton
Rod Dickson
Penrose
Wellington
Hamilton
Palmerston North
Christchurch North
Report on NODS