An effective hospital occupational health program should provide, but is not limited to, the following services:

A. Preplacement physical examinations, including a complete medical history

B. Periodic health appraisal examinations

C. Health and safety education

D. Immunizations

E. Care for illness and injury at work

F. Health counseling

G. Environmental control and surveillance

H. Health and safety records system

I. Coordinated planning with hospital departments and services

The established guidelines are outlined as follows.

A. PREPLACEMENT PHYSICAL EXAMINATIONS

1. Physical examinations should be given to all new workers and should include:

a. Routine blood tests


(1) Complete blood count
(2) Fasting blood sugar or 2-hr postprandial
(3) Renal function tests
(4) Creatinine
(5) SGOT
(6) SGPT
(7) Serology for syphilis
(8) Serology for rubella
(9) Others at the physician's discretion, guided by the worker's medical history

b. Routine urinalysis

c. Electrocardiogram for workers over age 35 at the physician's discretion

d. Chest X-ray, posterior and anterior and lateral

e. Skin testing for TB

f. Vision tests (near and far, with and without correction) and tonometry

g. Audiogram, speech range

h. Cervical cytology (Pap smear) for females

2. A record of the occupational history of the worker should be included in the preplacement examination.

B. PERIODIC HEALTH APPRAISAL EXAMINATIONS

Periodic health appraisal examinations should be provided for the following:

1. Workers who are exposed to hazardous environments,

2. Workers who are returning from an absence caused by illness or injury,

3. Workers who are being transferred to another department or service, and

4. Workers who are retiring.

In addition to job orientation, a program instructed by a knowledgeable person should provide health, safety, and environmental information for all workers on a continuing basis.

The instruction should include information on safe working habits, relevant health information, and use of the occupational health unit for reporting injuries and illnesses.

D. IMMUNIZATIONS

1. Immunizations should be provided in accordance with the Centers for Disease Control (CDC) policy for hospital workers.**

2. Elective immunizations should be considered for special situations such as epidemics, unusual laboratory conditions, or accidental exposures (e.g., HBV needlestick accident).

3. A suspense system for updating immunizations should be maintained.

1. A specific site within the hospital should be available for workers to receive medical, psychological, and other consultative services on a 24-hr basis.

2. An adequate facility should be provided to give medical, surgical, psychological, and rehabilitative services to all workers.

3. A competent consulting staff should be maintained.

4. A formal procedure should be outlined for contacting a family or a private physician.

5. Adequate followup measures for facilitating continuity of care should be maintained for all workers.

6. Treatment and reporting of occupational injuries and illnesses should conform to the State compensation laws and to OSHA standards under Public Law 91-596, the Occupational Safety and Health Act of 1970.

1. A program should be made accessible and available to provide medical, psychological, and social counseling. Such counseling should include help for workers with various addictive problems (i.e., tobacco, drugs, food, and alcohol), as well as for those with problems associated with HIV infection and the HIV epidemic.

2. A formal system for referral and review should be provided for workers with problems that need professional intervention unavailable in the facility.

3. Where a social service or psychiatric department is not available, persons with special interests or training should be designated to assist in counseling sessions.

1. An environmental control and surveillance program should be part of the occupational health program and should be directed by an individual or consultant capable of managing harmful exposures in the hospital.

2. A single individual should be responsible for nuclear medicine and radiological activities.

3. Conformance should be maintained to State and Federal rules and regulations pertaining to radiation and safety hazards.

1. Each worker should have a health record maintained in the health unit. The record should include all examinations, reports of injuries and illnesses, reports to and from physicians, and all other safety and health matters.

2. Reports should be kept on a monthly and yearly basis to indicate injury and illness rates, accident facts, and reports on the monitoring and control of environmental hazards.

3. Records should be confidential and should be available only to appropriate personnel.

1. A committee that represents all hospital departments and services should advise the hospital administration on the policy, direction, and requirements of the occupational health program.

2. A safety committee and an infection control committee should consider the health of all workers in their planning.

3. A member of the hospital's occupational health program should be on both the safety committee and the infection control committee.

*Adapted from: NIOSH (1977). Hospital occupational health and safety. Cincinnati, OH: U.S. Department of Health, Education and Welfare, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, DHEW (NIOSH) Publication No. 77-141.

**See Appendix 8 of this document.