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MANAGING BEST PRACTICES: Trends in health surveillance

Work site health surveillance is the systematic collection, analysis, and interpretation of health data to improve employee health and safety and benefit other parties as well. In this article weâ€™ll review current and future directions for health surveillance â€” an increasingly important business necessity for employers and EHS pros.

First, what makes up health surveillance? Itâ€™s best measured by a risk assessment audit that includes exposure surveillance and medical surveillance.

Industrial hygiene monitoring results can be viewed as exposure surveillance. Employee medical exams specified for employees exposed to workplace hazards (hearing tests for employees exposed to noise, for example) can be viewed as medical surveillance.

OSHAâ€™s standard on employee access to medical and exposure records (29 CFR 1910.1020) is the most prominent regulation to address work site health surveillance.

Due to OSHA regulations, most IH emphasis has been on individual hazards (monitoring for regulated chemicals). This alone does not meet good workplace health surveillance objectives. Today, Haz-Map (http://hazmap.nlm.nih.gov/), a database on jobs and occupational diseases, is more important to health surveillance than an employeeâ€™s current hazard inventory.

Beyond OSHA

Where can you find the results of health surveillance efforts? Occupational injury and illness statistics collected from work sites and maintained by the U.S. Bureau of Labor Statistics (http://www.bls.gov/) is a familiar example of a workplace health surveillance database.

But BLS data is just the tip the iceberg. Employers and EHS pros must remain alert to how expanded and new public health surveillance databases impact work site health surveillance. Hereâ€™s how these new databases can work:

Beginning in 1997, blood lead test results from laboratories in Michigan became reportable to the Michigan Department of Community Health. Test results became part of a public health surveillance system that included patient interviews. MDCHâ€™s health surveillance data for lead from 1998-2001 found that:

1,907 workers had blood lead level (BLL) equal or greater than 10 micrograms per deciliter;

70 percent of patients interviewed with elevated BLL experienced health symptoms below the limits permitted by workplace regulations; and,

50 percent of children of lead-exposed workers who were tested had elevated BLL.

How did MDCH use the data to improve health and safety for employees and other parties? MDCH referred 81 companies to Michigan OSHA for inspections and 72 percent of these companies were cited for violations of workplace standards for lead.

MDCH also provided recommendations to the state to test the BLL of children of lead-exposed workers and mandate laboratory reporting of mercury, arsenic, and cadmium.

Plus, MDCH provided state lead results to the U.S. Centers for Disease Control and Prevention (CDC) Adult Blood lead Epidemiology and Surveillance (ABLES) program for further public health interventions.

State reporting expands

Lead exposure is just one of more than a dozen work-related health conditions that should come under surveillance, according to the Council of State and Territorial Epidemiologists (CSTE). Based upon recommendations from CSTE, most states now require that physicians, hospitals, clinics, and laboratories report (most often to the state public health department) all known or suspected cases of occupational disease.

In New York, for instance, every physician, healthcare facility and clinical laboratory treating a person with clinical evidence of occupational lung disease must report to the Department of Public Health such occurrence within ten days of diagnosis.

Some states include a catch-all category for reporting occupational disease. Massachusetts law, for example, states: â€œReport any work-related disease outbreak/cluster, regardless of whether or not the disease is included among the reportable conditions.â€

Linking health data

Since 9/11, public health surveillance has expanded greatly through various laws and substantial funding. The intent is to detect as early as possible disease outbreak that may be caused by terrorists. Databases are now linked to find information such as a patientâ€™s chief complaints in emergency departments, clinical impressions on ambulance log sheets, prescriptions filled, retail drug (over-the-counter) purchases, school or work absenteeism, and patterns of medical signs and symptoms in persons seen in various clinical settings.

CDCâ€™s Wonder web site (http://wonder.cdc.gov/) provides a snapshot of growing public health data.

CDC also announced this year that NIOSH will become part of the new â€œCoordinating Center for Environmental Health, Injury Prevention, and Occupational Health.â€ Some EHS pros argue that this action might diminish NIOSHâ€™s role in helping protect worker health and safety, but the move should help integrate worker health and safety into the broader public health and safety picture.

SIDEBAR: Resources

In 2001, NIOSH held a three-day workshop on â€œBest Practices in Workplace Surveillance,â€ http://www.cdc.gov/niosh/sbw/.

Another resource on the topic is Epidemiological Surveillance, Chapter 5, in the American Industrial Hygiene Associationâ€™s text: The Occupational Environment: Its Evaluation, Control, and Management (2003).

Rohm and Haas Company provides an online description of their workplace health surveillance programs. See http://www.rohmhaas.com/EHS/ehs/healthprog.html.

For readers who have epidemiological training, the CDCâ€™s Division of Public Health Surveillance and Informatics provides a free downloadable software program (April 2004) called Epi Infoâ„¢ (http://www.cdc.gov/epiinfo/).

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