10 PUBH 5121 Health Risk Assessment

Recommended Readings:

• Robinson, L. (2018). A practical guide to toxicology and human health risk assessment. John Wiley & Sons. (Available Online on CBU Library)
  • Chapter 11 Human Health Risk Assessment

• Health and Safety in Canadian Workplaces (Open Book) (Athabasca University Press)
  • Hazard Recognition, Assessment and Control

Section 1: Introduction

• What is Health Risk Assessment?

  • Human Health Risk Assessment (EPA, US)
  • Risk Assessment (CCOHS)

• Use in OHS

  • Occupational Risk Assessment (NIOSH, CDC)
    • Overview
    • How NIOSH Conducts Risk Assessments
      1. Identifying the hazard
      2. Assessing the exposure-response relationship
      3. Characterizing workplace risk
      4. Frequently Asked Questions
    • Impact of NIOSH Risk Assessments
  • Occupational Health and Safety Risks in the Healthcare Sector – Guide to prevention and good practice (PDF) (ILO, EC)
    • Please read:

• • • • Chapter 3 Biological Risks
      • Chapter 4 Musculoskeletal Risks

• • • • Chapter 5 Psychosocial Risks

• • • • Chapter 6 Chemical risks

• Risk, Hazard Exposure in OHS

  • Hazard and Risk (CCOHS)

Section 2: Planning

• Conducting a Human Health Risk Assessment – Planning and Scoping (EPA, US)

Section 3: Hazards and Hazard Identification

• Types of hazards

  • Hazards & Exposures (WorkSafe BC)

1. 1. 1. 1. Biological Hazards
         2. Bullying & Harassment
         3. Chemical & Materials
         4. Cold Water Immersion
         5. Confined Spaces
         6. Driving for Work
         7. Electricity
         8. Ergonomics
         9. Excavations
         10. Extreme Temp.
         11. Falls from Elevation
         12. Fatigue Impairment
         13. Lifting & Handling
         14. Noise
         15. Radiation
         16. Slips, Trips & Falls
         17. Substance Use & Impairment in the Workplace
         18. Vibration
         19. Violence
         20. WHMIS
         21. Wildlife & Insects
         22. Working Alone or in Isolation

• A-Z hazard library (Safe Work Australia)

• Epidemiology role in hazard identification

  • WHO – Evaluation and Use of Epidemiological Evidence for Environmental Health Risk Assessment Guideline Document (PDF) 

  • Journal Articles

    • Role of epidemiology in risk assessment: a case study of five ortho-phthalates
      • Maffini, M. V., Geueke, B., Groh, K., Carney Almroth, B., & Muncke, J. (2021). Role of epidemiology in risk assessment: A case study of five ortho-phthalates. Environmental Health, 20(1), 1-14.
    • Invited Commentary: Epidemiology and Risk Assessment (Full Article) (America Journal of Epidemiology)
      • Samet, J. M., Schnatter, R., & Gibb, H. (1998). Invited commentary: epidemiology and risk assessment. American Journal of Epidemiology, 148(10), 929-936.

• Methods

  • Use of Safety Data Sheet

1. 1. 1. Chemical safety data sheets (HSE, UK)
         • help users of those chemicals to assess risk
      2. WHMIS 2015 – Safety Data Sheet (SDS)

• • Determine Reliability, relevance and adequacy of the data

• • • Assessing Data Reliability (PDF) (GAO, US)
      • Understanding Data Reliability
        • Deciding Whether a Data Reliability Assessment I Necessary
        • Determining the Extent of the Assessment
        • Steps for Collecting Information When Assessing Data Reliability
        • Making the Data Reliability Determination
        • Including Appropriate Language in the Report
        • Additional Considerations
    • Weight of Evidence/Uncertainty in Hazard Assessment (ECHA, EU)
      • Page 7 Quality of Data
    • Klimisch Score:
      1. In: Guidance on information requirements and chemical safety assessment Chapter R.4: Evaluation of available information (ECHA, EU)
         • Section R.4.2 Reliability of information (P.3)
           • 1 = reliable without restrictions
           • 2 = reliable with restrictions
           • 3 = not reliable
           • 4 = not assignable
      2. How to Use Klimisch Scoring System to Assess Data Reliability (ChemSafetyPro)

      3. The Original Journal Article

         A Systematic Approach for Evaluating the Quality of Experimental Toxicological and Ecotoxicological Data (PDF) (Full Article) (Lead Ammunition Group, UK)

         • Klimisch, H. J., Andreae, M., & Tillmann, U. (1997). A systematic approach for evaluating the quality of experimental toxicological and ecotoxicological data. Regulatory toxicology and pharmacology, 25(1), 1-5.

• • • Hazard Identification in Real World Example:
      1. Identifying hazards (WorkSafe BC)
         • Contains workplace inspection instruction and steps to identify hazards (Refer to PUBH 5135 Occupational Health and Safety Regulation – Topic 12 VARIOUS TYPES OF INSPECTION IN THE WORKPLACE)
      2. Identidy Hazards & Manage Risk (go2HR, BC’s tourism and hospitality human resource and health & safety association)
         • Hazard Identification, Risk Assessment and Control Policy
         • Hazard IDentification & Risk Assessment Tool for Ski Areas 
  • Absence of Data Doesn’t Mean No Hazard

    • Journal Article

      Absence of evidence is not evidence of absence (Full Article)

      • Alderson P. (2004). Absence of evidence is not evidence of absence. BMJ (Clinical research ed.), 328(7438), 476–477. https://doi.org/10.1136/bmj.328.7438.476

Section 4: Hazard Characterization

1. • 1. Identify all relevant dose descriptors
     2. dose–response assessment
     3. Determine dose response relationship
     4. Find out the point of departure (the ref. point)
     5. High to Low Dose and Animal to Humans Extrapolation
     6. Find Out The benchmark dose (BMD) and The benchmark response (BMR)
   • Software for Benchmark Dose Estimation
     • Benchmark Dose Tools (EPA, US)
       • About BMDS
       • About CatReg
   • Some References and guidelines
     • WHO Hazard Characterization for Pathogens in Food and Water
   • Hazard Characterization and Tools for Health Risk Assessment under CMP (Governemnt of Canada)

Section 5: Exposure Assessment

• • Route of exposure (OHS)
    • Toxicology in Occupational and Environmental Setting (PDF) (WILEY-VCH, Germany)
      • Please read:
        • Route of Exposure (P.19 – 20)
  • Susceptible person
    • How Infections Spread (CDC)
      • Please read:
        • Susceptible Person
  • How to measure exposure
    • Exposure Assessment Tools by Approaches (EPA, US)

• • • • Direct vs indirect exposure assessment
      • Measure or Model Exposure?
        • Computer aided model exposure examples:
          1. ECETOC TRA Model
          2. RISKOFDERM model
          3. Advanced REACH Tool, ART
          4. QSAR TOOLBOX (free of charge)
          5. EUSES – European Union System for the Evaluation of Substances (free of charge)
             • For Predicted Environmental Concentrations (PEC) and human exposure

Section 6: Risk Characterization

• •  Phases of ERA – Risk Characterization (EPA, US)
  • Risk Characterization Handbook (PDF)(EPA, US)
  • Guidance on Information Requirements and Chemical Safety Assessment Part E: Risk Characterisation (ECHA, EU)
    • Introduction (P.8)
      1. Predicted No-effect Concentrations (PNECs), Derived No Effect Level (DNEL)
    • Assessment steps (P.9)
    • Risk characterisation for physicochemical properties (P.11)
    • Human health hazard assessment of physicochemical properties (P.12)
    • Risk Management Measures (P.14 – 15)
    • Risk characterisation for human health (Steps 1-5) (P.17)
    • Risk characterisation for the environment (steps 1-5) (P.40)
    • Calculate Risk Characterization Ratio (P.41)
  • Use of margins of exposure and risk quotients in risk assessment (Government of Canada)
  • Risk Characterization (Indian Institute of Technology Roorkee)

• • • Exposure = Intensity x Frequency x Duration
      • How much
      • How Often
      • How Long

Section 7: Risk Management, Control and Communication

• Risk Management and Control:

  • Risk Management Framework: All Steps (PDF) (uWaterloo)
  • Guide to Integrated Risk Management (Government of Canada)
  • Handbook of Occupational Hazards and Controls for Public Health Workers (PDF) (Government of Alberta)

• Risk Communication:

  • When Communication Failed, What are the Consequences?

1. 1. • Mad Cows, and Mother’s Milk: The Perils of Poor Risk Communication (Overview) (Researchgate.net)

• • • • William Leiss. (2004). Mad Cows and Mother’s Milk, Second Edition : The Perils of Poor Risk Communication: Vol. 2nd ed. McGill-Queen’s University Press.
      • (Full book available on CBU Library Online – choose “SUBSCRIBE_EBSCOCANADIANCOLLECTION”)

• • • Communication Lesson from the Father of Hand Hygiene and Nurse Florence Nightingale
      1. A History Lesson On The Dangers Of Letting Data Speak For Itself (Forbes)
      2. Communication: Semmelweis vs Florence Nightingale (chacunningham.wordpress.com)
    • Learning from 311 Japan Radiation Crisis
      • Poor risk communication in Japan is making the risk much worse (Scientific American)
    • Lesson from Acrylamide

      • Journal Article

        Acrylamide: Lessons for risk management and communication (Academic Journals, available on CBU Library Online)

        • Renn, O. (2003). Acrylamide: Lessons for risk management and communication. Journal of Health Communication, 8(5), 435-441.

• Risk Communication in Practice

  • Risk Communication (Peter N. Sandman)
    • Articles: Risk Communication
    • Peter Sandman on Risk Communication Vimeos Series:

1. • Assessing, communicating, and managing risk in general practice

• • • Trevena, L. (2014). Assessing, communicating, and managing risk in general practice. British Journal of General Practice, 64(621), 166-167. https://bjgp.org/content/64/621/166.full
  • Recommendations for Improving Risk Communication (NIH National Library of Medicine, US)

Section 8: Other Resources

• A handbook for Alberta employers and workers: Hazard Assessment and Control

• Journal Article

  Occupational health and safety hazards faced by healthcare professionals in Taiwan: A systematic review of risk factors and control strategies

  • Che Huei, L., Ya-Wen, L., Chiu Ming, Y., Li Chen, H., Jong Yi, W., & Ming Hung, L. (2020). Occupational health and safety hazards faced by healthcare professionals in Taiwan: A systematic review of risk factors and control strategies. SAGE open medicine, 8, 2050312120918999. https://doi.org/10.1177/2050312120918999
• Infection Prevention and Control (IPAC) Program Standard (PDF)(IPAC Canada) 
• Framework for Human Health Risk Assessment to Inform Decision Making (PDF) (EPA, US) 
• Guidance on Human Health Risk Assessment (PDF) (Northern Health, BC)  
• Hazard Characterization and Tools for Health Risk Assessment under CMP