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Best Practices in Workplace Surveillance

A Model Medical Surveillance Program For Persons in Hazardous Waste Operations

Phil Jones, Peter P. Greaney, Marion J. Fedoruk

The paper describes a standardized medical surveillance program for a company engaged in hazardous waste operations at multiple locations in North America. The company implemented a program in 1987 to comply with the OSHA hazardous waste operations regulations. The initial program had deficiencies including: 1) lack of consistency in medical testing between different sites: 2) difficulty maintaining confidentially: 3) differences in occupational medicine expertise among examiners which could affect occupational disease recognition and/or employee risk factor screening.

The program incorporated tools to assess individual employee exposures and applied multidisciplinary input from occupational health professionals (industrial hygienists and occupational medicine specialists) to develop a comprehensive medical examination protocol with central data review. The Employee Exposure Assistance (EAS) form is completed annually by employees and categorizes chemical and physical hazard exposure potential. Program implementation resulted in an overall reduction of medical examinations and an improvement in the quality of both biological monitoring decisions/data and medical evaluations.

Approximately 2900 employees are currently enrolled. About 14,000 examinations were conducted in the past 14 years representing one of the largest studied populations. Initially, annual biological monitoring tests for lead, PCB's, arsenic and cholinesterase levels were conducted but discontinued after tissue levels revealed concentrations in the general population range. Subsequent biological monitoring was targeted to hazards identified by EAS and site-specific activities with recognized exposure potential that could be effectively monitored. No unusual tissue levels have been measured indicating overall effectiveness of exposure control measures for this population. Although some employees had developed conditions from known exposure incidents, no previously unidentified occupational disease cases from hazardous waste exposures were identified during routine examinations. The examinations identified medical conditions that could preclude safe performance of critical tasks. The study demonstrates how monitoring program weaknesses can be overcome by appropriate standardization of monitoring tools combined with centralized procedures.

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