Workplace health surveillance or occupational health surveillance (U.S.) is the ongoing systematic collection, analysis, and dissemination of exposure and
health data
Health data is any data "related to health conditions, reproductive outcomes, causes of death, and quality of life" for an individual or population. Health data includes clinical metrics along with environmental, socioeconomic, and b ...
on groups of workers.
[ ] The Joint
ILO
The International Labour Organization (ILO) is a United Nations agency whose mandate is to advance social and economic justice by setting international labour standards. Founded in October 1919 under the League of Nations, it is the first and ol ...
/
WHO
Who or WHO may refer to:
* Who (pronoun), an interrogative or relative pronoun
* Who?, one of the Five Ws in journalism
* World Health Organization
Arts and entertainment Fictional characters
* Who, a creature in the Dr. Seuss book ''Horton Hear ...
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
Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at wor ...
and is frequently confused with
medical screening
Screening, in medicine, is a strategy used to look for as-yet-unrecognised conditions or risk markers. This testing can be applied to individuals or to a whole population. The people tested may not exhibit any signs or symptoms of a disease, or t ...
. 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.
Aspects
Medical surveillance
The mission of a medical surveillance program is to keep workers healthy and ensure that employers are meeting
OSHA
OSHA or Osha may refer to:
Work
* Occupational Safety and Health Administration, a federal agency of the United States that regulates workplace safety and health
* Occupational Safety and Health Act (United States) of 1970, a federal law in the Un ...
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
Employment is a relationship between two party (law), parties Regulation, regulating the provision of paid Labour (human activity), labour services. Usually based on a employment contract, contract, one party, the employer, which might be a co ...
and
environmental medicine
Environmental medicine is a multidisciplinary field involving medicine, environmental science, chemistry and others, overlapping with environmental pathology. It can be viewed as the medical branch of the broader field of environmental health. Th ...
physicians,
mid-level practitioner
Mid-level practitioners, also called non-physician practitioners or advanced practice providers, are health care providers who have a defined scope of practice. The term ''mid-level'' refers to the complexity of healthcare situations they handle, ...
s, 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
Engineering controls are strategies designed to protect workers from hazardous conditions by placing a barrier between the worker and the hazard or by removing a hazardous substance through air ventilation. Engineering controls involve a physic ...
,
administrative controls
Administrative controls are training, procedure, policy, or shift designs that lessen the threat of a hazard to an individual. Administrative controls typically change the behavior of people (e.g., factory workers) rather than removing the actu ...
, and
personal protective equipment
Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, elec ...
. 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
Screening, in medicine, is a strategy used to look for as-yet-unrecognised conditions or risk markers. This testing can be applied to individuals or to a whole population. The people tested may not exhibit any signs or symptoms of a disease, or t ...
, 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 () when respirators are necessary to protect worker health. Likewise, the OSHA standard for occupational exposure to hazardous chemicals in laboratories () 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
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. 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
Exposure assessment is a branch of environmental science and occupational hygiene that focuses on the processes that take place at the interface between the environment containing the contaminant of interest and the organism being considered. ...
. 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
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evidenc ...
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.
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
The National Institute for Occupational Safety and Health (NIOSH, ) 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 C ...
(
NIOSH
The National Institute for Occupational Safety and Health (NIOSH, ) 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 C ...
) to form the Occupational Health Surveillance Work Group in order to prioritize occupational health conditions to be placed under surveillance.
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.
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.
Data Sources
Data for the OHIs come from multiple sources including:
*
Death certificate
A death certificate is either a legal document issued by a medical practitioner which states when a person died, or a document issued by a government civil registration office, that declares the date, location and cause of a person's death, as ...
s, with contributing and underlying causes of death, which all states send to the
National Vital Statistics System The National Vital Statistics System (NVSS) is an inter-governmental system of sharing data on the vital statistics of the population of the United States. It involves coordination between the different state health departments of the US states and ...
in CDC's
National Center for Health Statistics
The National Center for Health Statistics (NCHS) is a U.S. government agency that provides statistical information to guide actions and policies to improve the public health of the American people. It is a unit of the Centers for Disease Control ...
*
Cancer registries, such as the
North American Association of Central Cancer Registries
The North American Association of Central Cancer Registries, Inc. (NAACCR), established in 1987, is a collaborative umbrella organization for cancer registries, governmental agencies, professional associations, and private groups in North Amer ...
* State hospital discharge data
* State Worker's Compensation systems
* Occupational safety and health professionals
* Survey of occupational injuries and illnesses, with results provided in the
Bureau of Labor Statistics
The Bureau of Labor Statistics (BLS) is a unit of the United States Department of Labor. It is the principal fact-finding agency for the U.S. government in the broad field of labor economics and statistics and serves as a principal agency of t ...
(BLS) Annual Survey of Occupational Injuries and Illnesses
* BLS Census of Fatal Occupational Injuries
*
Poison Control Centers
A poison control center is a medical service that is able to provide immediate, free, and expert treatment advice and assistance over the telephone in case of exposure to poisonous or hazardous substances. Poison control centers answer questions ...
(PCCs), which submit real-time data to the
American Association of Poison Control Centers
The American Association of Poison Control Centers (AAPCC) is a national nonprofit organization founded in 1958 that represents the nation's 55 poison centers. The AAPCC supports poison centers in their public health mission to prevent poisonin ...
for inclusion in the Toxic Exposure Surveillance System
*
Adult Blood Lead Epidemiology and Surveillance
The US National Institute for Occupational Safety and Health funds the Adult Blood Lead Epidemiology and Surveillance (ABLES) program, a state-based surveillance program of laboratory-reported adult blood lead levels.
In 2009, the ABLES program up ...
(ABLES)
* OSHA's Integrated Management Information System (IMIS), which maintains worksite inspection data to determine compliance with health and safety standards
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
In analytical chemistry, biomonitoring is the measurement of the body burden of toxic chemical compounds, elements, or their metabolites, in biological substances. Often, these measurements are done in blood and urine. Biomonitoring is performed ...
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.
![HearingExam](https://upload.wikimedia.org/wikipedia/commons/f/fa/HearingExam.jpg)
Medical surveillance tools
* General
** Epidemiological
cohort
Cohort or cohortes may refer to:
* Cohort (educational group), a group of students working together through the same academic curriculum
* Cohort (floating point), a set of different encodings of the same numerical value
* Cohort (military unit), ...
and
case–control studies investigate associations between causative agents and specific health effects.
**
Physical examinations
In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patient ...
assess the overall well-being of the worker and identify health-related issues.
* Chemical or particulate exposures
**
Pulmonary function testing
Pulmonary function testing (PFT) is a complete evaluation of the respiratory system including patient history, physical examinations, and tests of pulmonary function. The primary purpose of pulmonary function testing is to identify the severity ...
is a way to measure lung function. It can assist in the early detection of occupational lung diseases and provides information about the severity and staging of asthma and other restrictive lung diseases.
***
Spirometry
Spirometry (meaning ''the measuring of breath'') is the most common of the pulmonary function tests (PFTs). It measures lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is he ...
tests measure how quickly air can be pushed out from the lungs and is useful in evaluating diseases that cause obstruction to flow.
***
Plethysmography
A plethysmograph is an instrument for measuring changes in volume within an organ or whole body (usually resulting from fluctuations in the amount of blood or air it contains). The word is derived from the Greek "plethysmos" (increasing, enla ...
measures lung volume by having the subject perform breathing tests inside of an air tight box.
*** Flow rates can be measured by asking subjects to blow air out of the lungs as fast and as hard as possible from their largest inhaled breathe (inspiration) to the maximum exhaled breathe (expiration). The volume exhaled in the first second is called the forced expiratory volume in one second (
FEV1
Spirometry (meaning ''the measuring of breath'') is the most common of the pulmonary function tests (PFTs). It measures lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is h ...
). These flow rates can be indicators of disease that cause obstruction to airflow, such as asthma, chronic bronchitis, and emphysema.
**
Biomonitoring
In analytical chemistry, biomonitoring is the measurement of the body burden of toxic chemical compounds, elements, or their metabolites, in biological substances. Often, these measurements are done in blood and urine. Biomonitoring is performed ...
measures total body burden of a hazardous chemical in a worker via analysis of biological specimens such as urine or blood. Non-invasive procedures are preferred when possible.
* Noise exposures
**
Audiometry
Audiometry () is a branch of audiology and the science of measuring hearing acuity for variations in sound intensity and pitch and for tonal purity, involving thresholds and differing frequencies. Typically, audiometric tests determine a subje ...
remains the mainstay of diagnosis of
noise-induced hearing loss
Noise-induced hearing loss (NIHL) is a Hearing loss, hearing impairment resulting from exposure to loud sound. People may have a loss of perception of a narrow range of Frequency, frequencies or impaired perception of sound including hyperacusi ...
, which is the most common reported occupational disease in all parts of the world.
* Other
** Hand arm assessment (vibration) and dermatological assessments
(chemical) are other important tools for workplace health surveillance.
Confidentiality of information
Most countries have specific regulations for individual
health data
Health data is any data "related to health conditions, reproductive outcomes, causes of death, and quality of life" for an individual or population. Health data includes clinical metrics along with environmental, socioeconomic, and b ...
, 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.
References
External links
2013 Report on workplace accidents
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Workplace
Medical monitoring