Workplace health surveillance
|Hierarchy of hazard controls|
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. 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”.
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.
The mission of a medical surveillance program is to keep workers healthy and ensure that employers are meeting OSHA standards in health and safety. Medical surveillance has an emphasis on prevention: it is designed to detect potential workplace hazards before irreversible health effects can occur. 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.
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:
- An initial medical examination and collection of medical and occupational histories
- Periodic medical examinations at regularly scheduled intervals, including specific medical screening tests when warranted
- More frequent and detailed medical examinations as indicated on the basis of findings from these examinations
- Post-incident examinations and medical screening following uncontrolled or non-routine increases in exposures such as spills
- Worker training to recognize symptoms of exposure to a given hazard
- A written report of medical findings
- 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.
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 C.F.R. 1910.134) when respirators are necessary to protect worker health. Likewise, the OSHA standard for occupational exposure to hazardous chemicals in laboratories (29 C.F.R. 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.
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. 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.
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.
- Availability of easily obtainable statewide data
- Public health importance of the occupational health effect or exposure to be measured
- Potential for intervention activities
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 (very common in most of the undeveloped and developing countries), inability to diagnose the etiology by the occupational health care workers and availability of the data such as municipal death records.
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The most important tool is biomonitoring, which indicates the total body burden of a hazardous chemical in a worker by means of the laboratory investigations using biological specimens like urine or blood. The best practice is to use non-invasive procedures as far as possible for this purpose.
Other tools for workplace health surveillance include physical examinations and epidemiological cohort and case control studies. The pulmonary function testing is the mainstay of early detection occupational lung diseases. This test gives information about severity and staging of asthma and other restrictive lung diseases. The FEV1 is an important screening test. Pulmonary function testing combined with plathysmography reflects a very clear picture of status of lung functions of the subject.
Audiometry remains the mainstay of diagnosis of noise-induced hearing loss which is the most common reported occupational disease in all parts of the world.
Hand arm assessment and dermatological assessments are other important tools for workplace health surveillance. The Occupational Health Safety Network (OHSN) is a secure electronic surveillance system developed by the National Institute for Occupational Safety and Health (NIOSH) to address health and safety risks among health care personnel. Hospitals and other healthcare facilities can upload the occupational injury data they already collect to the secure database for analysis and benchmarking with other de-identified facilities. NIOSH works with OHSN participants in identifying and implementing timely and targeted interventions. OHSN modules currently focus on three high risk and preventable events that can lead to injuries or musculoskeletal disorders among healthcare personnel: musculoskeletal injuries from patient handling activities; slips, trips, and falls; and workplace violence. OHSN enrollment is currently open to all U.S. healthcare facilities. OHSN may be expanded to other industry sectors in the future.
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. Workers should have the right to access this information whenever they wish.
This article incorporates public domain material from websites or documents of the National Institute for Occupational Safety and Health.
- "Current Intelligence Bulletin 65: Occupational Exposure to Carbon Nanotubes and Nanofibers". U.S. National Institute for Occupational Safety and Health. April 2013. p. 146. Retrieved 2017-04-27. This article incorporates text from this source, which is in the public domain.
- "Worker Health Surveillance". U.S. National Institute for Occupational Safety and Health. Retrieved 2017-04-27.
- "Occupational Safety and Health". International Labour Organization. Retrieved 2017-04-27.
- "About Us". University of California, Davis Medical Surveillance Program. Retrieved 2012-08-07.
- "Medical Screening and Surveillance". U.S. Occupational Safety and Health Administration. Retrieved 2012-08-07.
- "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. February 2009. pp. 3–5. Retrieved 2017-04-26. This article incorporates text from this source, which is in the public domain.
- Neeraj Gupta (India),Paola (Chile) and Tunde, Maria (Chile)