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Page last reviewed: 03/09/2007
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Medical Screening and Surveillance
Medical screening and medical surveillance are two fundamental strategies for optimizing employee health. Although the terms are often used interchangeably, they are quite distinct concepts. Medical screening is, in essence, only one component of a comprehensive medical surveillance program. The fundamental purpose of screening is early diagnosis and treatment of the individual and thus has a clinical focus. The fundamental purpose of surveillance is to detect and eliminate the underlying causes such as hazards or exposures of any discovered trends and thus has a prevention focus. Both can contribute significantly to the success of worksite health and safety programs. However OSHA "medical surveillance" requirements are generally clinically focused (e.g.,medical and work histories, physical assessment, biological testing) with information obtained from the clinical processes used in the monitoring and analysis elements of medical surveillance.
Medical screening and surveillance are addressed in specific standards for the general industry.
OSHA Standards
This section highlights OSHA standards, directives (instructions for compliance officers), and standard interpretations (official letters of interpretation of the standards) related to medical screening and surveillance.
Note: Twenty-five states, Puerto Rico and the Virgin Islands have OSHA-approved State Plans and have adopted their own standards and enforcement policies. For the most part, these States adopt standards that are identical to Federal OSHA. However, some States have adopted different standards applicable to this topic or may have different enforcement policies.
General Industry (29 CFR 1910)
- 1910 Subpart H, Hazardous materials
- 1910 Subpart I, Personal protective equipment [related topic page]
- 1910 Subpart Z, Toxic and hazardous substances
[related topic page]
- 1910.1001, Asbestos
[related topic page]
- Appendix H, Medical surveillance guidelines for asbestos
(Non-mandatory)
- 1910.1003, 13 Carcinogens (4-nitrobiphenyl, etc.)
- 1910.1004, alpha-Naphthylamine
- 1910.1006, Methyl chloromethyl ether
- 1910.1007, 3,3'-Dichlorobenzidine (and its salts)
- 1910.1008, bis-Chloromethyl ether
- 1910.1009, beta-Naphthylamine
- 1910.1010, Benzidine
- 1910.1011, 4-Aminodiphenyl
- 1910.1012, Ethyleneimine
- 1910.1013, beta-Propiolactone
- 1910.1014, 2-Acetylaminofluorene
- 1910.1015, 4-Dimethylaminoazobenzene
- 1910.1016, N-Nitrosodimethylamine
- 1910.1017, Vinyl chloride
- 1910.1018, Inorganic Arsenic
[related topic page]
- 1910.1025,
Lead [related topic page]
- 1910.1027, Cadmium [related topic page]
- 1910.1028, Benzene
[related topic page]
- Appendix C, Medical surveillance guidelines for benzene
- 1910.1029, Coke oven emissions
- Appendix B, Industrial hygiene and medical surveillance guidelines
- 1910.1030, Bloodborne pathogens [related topic page]
- 1910.1043, Cotton dust [related topic page]
- 1910.1044, 1,2-dibromo-3-chloropropane
- Appendix C, Medical surveillance guidelines for DBCP
- 1910.1045, Acrylonitrile
- Appendix C, Medical surveillance guidelines for acrylonitrile
- 1910.1047, Ethylene oxide
[related topic page]
- Appendix C, Medical surveillance guidelines for ethylene oxide
(Non-mandatory)
- 1910.1048, Formaldehyde [related topic page]
- 1910.1050, Methylenedianiline
- Appendix C, Medical surveillance guidelines for MDA
- 1910.1450, Occupational exposure to hazardous chemicals in the laboratories
Directives
- National Emphasis Program - Microwave Popcorn Processing Plants. DIR 11-01 (CPL 03), (2011, January 18). Similar to the expired 2007 NEP, CPL 03-00-005, and described policies and procedures for implementing an emphasis program to identify and reduce or eliminate exposures to butter-flavoring chemicals - such as diacetyl and chemical substitutes - used in microwave popcorn manufacturing facilities.
- National Emphasis Program - Facilities that Manufacture Food Flavorings Containing Diacetyl. CPL 03-00-011, (2009, October 30). Describes policies and procedures for implementing an emphasis program to identify and reduce or eliminate hazards associated with exposures to flavoring chemicals in any facility that manufactures food flavorings containing diacetyl. This instruction is available on the public page.
- National Emphasis Program - Microwave Popcorn Processing Plants. CPL 03-00-005, (2007, July 27) (Expired as of July 27, 2008). Described policies and procedures for implementing an emphasis program to identify and reduce or eliminate exposure to butter-flavoring chemicals - such as diacetyl - used in microwave popcorn manufacturing facilities.
- OSHA Medical Surveillance Regulations -- Genetic Testing. STD 01-23-004 [STD 1-23.4], (1980, August 22). Provides an interpretation of OSHA health standards that require medical surveillance programs specifying a medical history with family and occupational background, including genetic and environmental factors.
- Search all available directives.
Standard Interpretations
Medical Screening
Medical screening is a method for detecting disease or body dysfunction
before an individual would normally seek medical care. Screening tests are usually
administered to individuals without current symptoms, but who may be at high risk for
certain adverse health outcomes. The following references provide
information about medical screening and clinical evaluation.
Clinical Evaluation
Related Literature
- Murthy, L.I. and W.E. Halperin. "Medical Screening and Biological Monitoring: A Guide to the Literature for Physicians." Journal of Occupational and Environmental Medicine 37.2(1995, February): 170-184. Summarizes recommended medical tests (including biologic monitoring) by independent investigators as well as OSHA and the National Institute for Occupational Safety and Health (NIOSH). Provides guidance to occupational health professionals in accessing the pertinent literature.
- Terry, T.M. and G. Ryan. "Making Sense of OSHA Standards with Medical Requirements: Part 1." Applied Occupational and Environmental Hygiene 13.3(1998, March): 144-148.
Medical Surveillance
Medical surveillance is the analysis of health information to look for problems that may be occurring in the workplace that require targeted prevention. Thus, surveillance serves as a feedback loop to the employer. Surveillance may be based on a single case or sentinel event, but more typically uses screening results from the group of employees being evaluated to look for abnormal trends in health status. Surveillance can also be conducted on a single employee over time. Review of group results helps to identify potential problem areas and the effectiveness of existing worksite preventive strategies. The following resources contain medical surveillance information including specific hazards and surveillance guidelines.
- Surveillance.
National Institute for Occupational Safety and Health (NIOSH) Workplace Safety and
Health Topic.
- Indicators for Occupational Health Surveillance. Centers for Disease
Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR)
50(RR01);1-7, (2007, January 19).
- Health Hazard Evaluations. National Institute for Occupational Safety and
Health (NIOSH). NIOSH conducts investigations of possible health hazards
in the workplace to determine whether any substance normally found in the
place of employment has potentially toxic effects in such concentrations
as used or found.
- The Work-Related Lung Disease Surveillance Report, 2002 [14 MB PDF, 341 pages]. US Department of
Human Health Services (DHHS), National Institute for Occupation Safety and
Health (NIOSH) Publication No.
2003-111, (2002).
Provides national and state-specific data of pneumoconiosis and other
work-related respiratory conditions.
- TLV/BEI Resources. American
Conference of Governmental Industrial Hygienists (ACGIH).
This
organization of government and industrial hygienists publishes biological
exposure indices for use which can be used for criteria for evaluating
biological samples collected for medical surveillance.
- Tracking Occupational Injuries, Illnesses, and Hazards: The NIOSH Surveillance Strategic Plan.
US Department of Human Health Services (DHHS), National Institute for
Occupation Safety and Health (NIOSH) Publication No. 2001-118, (2001,
January). NIOSH embarked on a process to assess current surveillance needs
and to identify its goals for the next decade. The Surveillance Strategic
Plan is the result of that effort.
- Occupational Medical Examinations and Surveillance Manual [411 KB PDF, 75 pages]. US Department of Defense (DoD). Provides minimum standards for medial surveillance programs to help
occupational health professionals and others recognize and evaluate health
risks associated with specific workplace exposures.
- General Information. Chapter 1. Describes the general requirements for medical surveillance,
types of examinations, and record keeping.
- Medical Surveillance for OSHA-Regulated Exposures. Chapter 2. Describes OSHA related medical surveillance.
- Medical Surveillance Endorsed by the Department of Defense.
Chapter 3. Includes additional medical surveillance protocols endorsed by the DoD, where OSHA does not
provide guidance.
- A Guide for the Management, Analysis, and Interpretation of Occupational Mortality Data.
US Department of Human Health Services (DHHS), National Institute for
Occupational Safety and Health (NIOSH) Publication No. 90-115, (1990, September).
Provides guidelines for state health departments interested in
occupational mortality surveillance.
- For additional information, see OSHA's Safety and Health Topics Pages on:
Additional Information
Related Safety and Health Topics Pages
Other Resources
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