Workplace health surveillance

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Workplace health surveillance or occupational health surveillance (U.S.) is the ongoing systematic collection, analysis, and dissemination of exposure and health data on groups of workers. [1] [2] The Joint ILO/WHO Committee on Occupational Health at its 12th Session in 1995 defined an occupational health surveillance system as "a system which includes a functional capacity for data collection, analysis and dissemination linked to occupational health programmes". [3]

Contents

The concept is new to occupational health and is frequently confused with medical screening. Health screening refers to the early detection and treatment of diseases associated with particular occupations, while workplace health surveillance refers to the removal of the causative factors. [4]

Aspects

Medical surveillance

A video about medical testing at a workplace as part of a NIOSH Health Hazard Evaluation Program investigation

The mission of a medical surveillance program is to keep workers healthy and ensure that employers are meeting OSHA standards in health and safety. [5] Medical surveillance has an emphasis on prevention: it is designed to detect potential workplace hazards before irreversible health effects can occur. [6] Clinicians with expertise in occupational health, industrial exposures, and respiratory protection screen workers with physical examinations, blood testing, spirometry (a measurement lung function), and audiometry. Screenings are performed at set intervals, often annually. The clinicians providing medical surveillance services include board-certified occupational and environmental medicine physicians, mid-level practitioners, nurses, and NIOSH-certified spirometry technicians. [5] [6]

Medical surveillance targets actual health events or a change in a biologic function of an exposed person or persons. Medical surveillance is a second line of defense behind the implementation of direct hazard controls such as engineering controls, administrative controls, and personal protective equipment. NIOSH recommends the medical surveillance of workers when they are exposed to hazardous materials. The elements of a medical surveillance program generally include the following: [7]

  1. An initial medical examination and collection of medical and occupational histories
  2. Periodic medical examinations at regularly scheduled intervals, including specific medical screening tests when warranted
  3. More frequent and detailed medical examinations as indicated on the basis of findings from these examinations
  4. Post-incident examinations and medical screening following uncontrolled or non-routine increases in exposures such as spills
  5. Worker training to recognize symptoms of exposure to a given hazard
  6. A written report of medical findings
  7. Employer actions in response to identification of potential hazards

When the purpose of a medical surveillance program is to detect early signs of work-related illness and disease, it is considered a type of medical screening, to detect preclinical changes in organ function or changes before a person would normally seek medical care and when intervention is beneficial The establishment of a medical screening program should follow established criteria, and specific disease endpoints must be able to be determined by the test selected. [7]

Medical examinations and tests are used in many workplaces to determine whether an employee is able to perform the essential functions of the job. Medical surveillance of workers is also required by law in the United States when there is exposure to a specific workplace hazard, and OSHA has a number of standards that require medical surveillance of workers In addition to substance-specific standards, OSHA has standards with broader applicability. For example, employers must follow the medical evaluation requirements of OSHA's respiratory protection standard ( 29 CFR 1910.134 ) when respirators are necessary to protect worker health. Likewise, the OSHA standard for occupational exposure to hazardous chemicals in laboratories ( 29 CFR 1910.1450 ) requires medical consultation following the accidental release of hazardous chemicals. NIOSH also recommends medical surveillance, including screening, of workers when there is exposure to certain occupational hazards. [7]

Hazard surveillance

Hazard surveillance involves identifying potentially hazardous practices or exposures in the workplace and assessing the extent to which they can be linked to workers, the effectiveness of controls, and the reliability of exposure measures. Workplace hazards can be chemical, biological, physical, ergonomic, psychosocial, or safety-related in nature. [8] Hazard surveillance is an essential component of any occupational health surveillance effort and is used for defining the elements of the risk management program. Critical elements of a risk management program include recognizing potential exposures and taking appropriate actions to minimize them (for example, implementing engineering controls, employing good work practices, and using personal protective equipment). Hazard surveillance should include the identification of work tasks and processes that involve the production and use of hazardous materials, and should be viewed as one of the most critical components of any risk management program. [7]

Hazard surveillance includes elements of hazard and exposure assessment. The hazard assessment involves reviewing the best available information concerning toxicity of materials. Such an assessment may come from databases, texts, and published literature or available regulations or guidelines. Human studies, such as epidemiologic investigations and case series or reports, and animal studies may also provide valuable information. The exposure assessment involves evaluating relevant exposure routes (inhalation, ingestion, dermal, and/or injection), amount, duration, and frequency (i.e., dose), as well as whether exposure controls are in place and how protective they are. When data are not available, this will be a qualitative process. [1]

Occupational Health Indicators (OHIs)

In 1998, the Council of State and Territorial Epidemiologists (CSTE) joined the CDC's National Institute for Occupational Safety and Health (NIOSH) to form the Occupational Health Surveillance Work Group in order to prioritize occupational health conditions to be placed under surveillance. [9] The Work Group recommended that states use 19 occupational health indicators based on the availability of easily obtainable statewide data, the public health importance of the occupational health effect or exposure, and the potential for intervention activities. [9]

These indicators are useful in assessing the ongoing policies and preventive measures but they also have some limitations. Among the major limitations are the underreporting of occupational health disorders, the inability to recognize potential occupational association of the disorder by health care workers, difficulties in attributing diseases with long latency or multiple causes (such as lung cancer) to occupational exposures, exclusion of special populations (such as self-employed or military personnel), and differences between state-specific databases. [9]

Data Sources

Data for the OHIs come from multiple sources including:

Tools

The usefulness of a surveillance tool may depend on what hazards are present in the workplace and the health effects those hazards may cause. For example, hearing tests will be helpful when noise exposures are present, while tests assessing lung function or biomonitoring may be useful when airborne agents are present. It is also important to distinguish between tools using medical surveillance (measuring health effects) and hazard surveillance/exposure assessment (physical measurements of the type and severity of hazard present). Periodic testing, including a baseline exam when an employee is hired, can often help detect a decline in function by comparing previous results. [15]

Hearing exam HearingExam.jpg
Hearing exam

Medical surveillance tools

Confidentiality of information

Most countries have specific regulations for individual health data, which require that the worker be informed if this information is ever shared with any third party. Occupational Health Records (OHR) have the same protections as any medical record that has confidential health information. Employers must store OHR in a secured area free from unauthorized access, use, or disclosure. Workers should have the right to access this information whenever they wish.

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<span class="mw-page-title-main">Personal protective equipment</span> Equipment designed to help protect an individual from hazards

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<span class="mw-page-title-main">National Institute for Occupational Safety and Health</span> US federal government agency for preventing work-related health and safety problems

The National Institute for Occupational Safety and Health is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services. Despite its name, it is not part of either the National Institutes of Health nor OSHA. Its current director is John Howard.

Occupational noise is the amount of acoustic energy received by an employee's auditory system when they are working in the industry. Occupational noise, or industrial noise, is often a term used in occupational safety and health, as sustained exposure can cause permanent hearing damage. Occupational noise is considered an occupational hazard traditionally linked to loud industries such as ship-building, mining, railroad work, welding, and construction, but can be present in any workplace where hazardous noise is present.

<span class="mw-page-title-main">Occupational hygiene</span> Management of workplace health hazards

Occupational hygiene is the anticipation, recognition, evaluation, control, and confirmation (ARECC) of protection from risks associated with exposures to hazards in, or arising from, the workplace that may result in injury, illness, impairment, or affect the well-being of workers and members of the community. These hazards or stressors are typically divided into the categories biological, chemical, physical, ergonomic and psychosocial. The risk of a health effect from a given stressor is a function of the hazard multiplied by the exposure to the individual or group. For chemicals, the hazard can be understood by the dose response profile most often based on toxicological studies or models. Occupational hygienists work closely with toxicologists for understanding chemical hazards, physicists for physical hazards, and physicians and microbiologists for biological hazards. Environmental and occupational hygienists are considered experts in exposure science and exposure risk management. Depending on an individual's type of job, a hygienist will apply their exposure science expertise for the protection of workers, consumers and/or communities.

<span class="mw-page-title-main">Chemical hazard</span> Non-biological substance that has the potential to cause harm to life or health

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A recommended exposure limit (REL) is an occupational exposure limit that has been recommended by the United States National Institute for Occupational Safety and Health. The REL is a level that NIOSH believes would be protective of worker safety and health over a working lifetime if used in combination with engineering and work practice controls, exposure and medical monitoring, posting and labeling of hazards, worker training and personal protective equipment. To formulate these recommendations, NIOSH evaluates all known and available medical, biological, engineering, chemical, trade, and other information. Although not legally enforceable limits, RELS are transmitted to the Occupational Safety and Health Administration (OSHA) or the Mine Safety and Health Administration (MSHA) of the U.S. Department of Labor for use in promulgating legal standards.

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A physical hazard is an agent, factor or circumstance that can cause harm with contact. They can be classified as type of occupational hazard or environmental hazard. Physical hazards include ergonomic hazards, radiation, heat and cold stress, vibration hazards, and noise hazards. Engineering controls are often used to mitigate physical hazards.

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<span class="mw-page-title-main">Safe-In-Sound award</span>

The Safe-in-Sound Excellence in Hearing Loss Prevention Award is an occupational health and safety award that was established in 2007 through a partnership between the National Institute for Occupational Safety and Health (NIOSH) and the National Hearing Conservation Association (NHCA). In 2018, the partnership was extended to include the Council for Accreditation in Occupational Hearing Conservation (CAOHC).

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References

PD-icon.svg This article incorporates public domain material from websites or documents of the National Institute for Occupational Safety and Health.

  1. 1 2 "Current Intelligence Bulletin 65: Occupational Exposure to Carbon Nanotubes and Nanofibers". U.S. National Institute for Occupational Safety and Health: 146. April 2013. doi: 10.26616/NIOSHPUB2013145 . Retrieved 2017-04-27.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  2. ↑ "Worker Health Surveillance". U.S. National Institute for Occupational Safety and Health. Retrieved 2017-04-27.
  3. ↑ "Occupational Safety and Health". International Labour Organization . Retrieved 2017-04-27.
  4. ↑ Eliasson, Kristina; Dahlgren, Gunilla; Hellman, Therese; Lewis, Charlotte; Palm, Peter; Svartengren, Magnus; Nyman, Teresia (2021-02-19). "Company Representatives' Experiences of Occupational Health Surveillance for Workers Exposed to Hand-Intensive Work: A Qualitative Study". International Journal of Environmental Research and Public Health. 18 (4): 2018. doi: 10.3390/ijerph18042018 . ISSN   1660-4601. PMC   7922478 . PMID   33669705.
  5. 1 2 "About Us". University of California, Davis Medical Surveillance Program. Retrieved 2012-08-07.
  6. 1 2 "Medical Screening and Surveillance". U.S. Occupational Safety and Health Administration . Retrieved 2012-08-07.
  7. 1 2 3 4 "Current Intelligence Bulletin 60: Interim Guidance for Medical Screening and Hazard Surveillance for Workers Potentially Exposed to Engineered Nanoparticles". U.S. National Institute for Occupational Safety and Health: 3–5. February 2009. doi: 10.26616/NIOSHPUB2009116 . Retrieved 2017-04-26.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  8. ↑ Safety, Government of Canada, Canadian Centre for Occupational Health and. "Hazards | Canadian Centre for Occupational Health and Safety". www.ccohs.ca. Retrieved 2018-01-29.
  9. 1 2 3 "Indicators for Occupational Health Surveillance" (PDF). Department of Health and Human Services, Centers for Disease Control and Prevention. January 19, 2007. Retrieved February 20, 2018.
  10. ↑ "Injuries, Illnesses, and Fatalities". www.bls.gov. Retrieved 2018-02-20.
  11. ↑ "Census of Fatal Occupational Injuries (CFOI) – Current and Revised Data". www.bls.gov. Retrieved 2018-02-20.
  12. ↑ "National Poison Data System". www.aapcc.org. Retrieved 2018-02-20.
  13. ↑ "CDC – Adult Blood Lead Epidemiology and Surveillance (ABLES) – NIOSH Workplace Safety and Health Topic". www.cdc.gov. 2018-01-19. Retrieved 2018-02-20.
  14. ↑ "Establishment Search Page | Occupational Safety and Health Administration". www.osha.gov. Retrieved 2018-02-20.
  15. ↑ "1910.1025 App B - Employee standard summary | Occupational Safety and Health Administration". www.osha.gov. Retrieved 2021-03-07.
  16. 1 2 3 4 "Occupational Medicine". www.iaff.org. Retrieved 2018-02-01.
  17. ↑ "OSHA Publications – Pulmonary Function Test | Occupational Safety and Health Administration". www.osha.gov. Retrieved 2018-02-01.
  18. ↑ "CDC – Spirometry – NIOSH Workplace Safety and Health Topic". www.cdc.gov. 2017-12-08. Retrieved 2018-02-01.
  19. ↑ "Biological monitoring (biomonitoring): OSHwiki". oshwiki.eu. Retrieved 2018-02-01.
  20. ↑ Walker, Jennifer Junnila; Cleveland, Leanne M.; Davis, Jenny L.; Seales, Jennifer S. (2013-01-01). "Audiometry Screening and Interpretation". American Family Physician. 87 (1): 41–47. ISSN   0002-838X. PMID   23317024.
  21. ↑ "HAVS risk assessment guide – SHP – Health and Safety News, Legislation, PPE, CPD and Resources". SHP – Health and Safety News, Legislation, PPE, CPD and Resources. 2008-09-21. Retrieved 2018-02-01.
  22. ↑ "Dermatology – Occupational Dermatology – Penn State Health". hmc.pennstatehealth.org. Retrieved 2018-02-01.
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