Occupational medicine practice focuses on preventing occupational diseases in workers who are exposed to particular chemical, biological, and physical workplace hazards. Medical surveillance is a core preventive clinical service that impacts individuals and groups whose occupation places them at significantly increased risk of a controllable disease.
Physicians provide medical surveillance services in several contexts: performing baseline medical surveillance examination, such as for a worker who is going to be (or already is) exposed to a regulated substance such as lead; as a consultant asked to interpret data from a medical surveillance program to identify trends or patterns and provide recommendations for further investigation or control; or as a medical-legal expert reviewing a case to retrospectively assess causation and the extent to which a worker's occupational disease was caused by or contributed to by a particular hazard.
Millions of workers in the United States alone are regularly exposed to one or more specific chemical or physical hazards that are regulated under the OSHA health standards (29CFR Part 1910.1001-1450). The figures in Table 41–1 do not include workers in mining who may have similar exposures but are not covered under specific Mine Safety and Health Administration (MSHA) health standards, or workers covered by surveillance programs for substances, hazardous occupations, or diseases outside the framework of a specific OSHA standard.
Table 41–1.OSHA health standards. Estimates of workers exposed to Chemical or Physical Hazards. ||Download (.pdf) Table 41–1. OSHA health standards. Estimates of workers exposed to Chemical or Physical Hazards.
|1910.xxxx ||Substance/Hazard ||# Workers ||Reference(s) and (Year) |
|95 ||Noise ||30,000,000 ||OSHA (2009), NIOSH (2009) |
|120 ||HazWaste/HazMat ||1,758,000 ||OSHA (1989) |
|134 ||Respirator ||4,953,568 ||OSHA (2009), OSHA (1998) |
|1001 ||Asbestos ||6,389,586 ||OSHA (1994) |
|1003 ||13 carcinogens || || |
|1017 ||Vinyl chloride || || |
|1018 ||Arsenic, inorganic ||660,000 ||OSHA (1998) |
|1025 ||Lead ||2,400,000 ||ATSDR 2005 (1978), OSHA (1993) |
|1026 ||Chromium, hexavalent ||558,000 ||OSHA (2006) |
|1027 ||Cadmium ||524,816 ||OSHA (1992) |
|1028 ||Benzene || || |
|1029 ||Coke-oven emissions ||6,135 ||OSHA (1998) |
|1030 ||Blood-borne pathogens ||5,576,026 ||OSHA (1991) |
|1043 ||Cotton dust || || |
|1044 ||1,2-Dibromo-3-chloropropane || || |
|1045 ||Acrylonitrile || || |
|1047 ||Ethylene oxide || || |
|1048 ||Formaldehyde ||2,156,801 ||OSHA (1992) |
|1050 ||Methylenedianiline ||3,836 ||OSHA (1992) |
|1051 ||1,3-Butadiene ||9,703 ||OSHA (1996) |
|1052 ||Methylene chloride ||237,496 ||OSHA (1997) |
|1450 ||Laboratory chemicals || || |
|132-138 ||All PPE (including Respirators) ||11,731,653 ||OSHA (1994) |
There is no single accepted definition of medical surveillance. NIOSH defines occupational health surveillance as “the tracking of occupational injuries, illnesses, hazards, and exposures.” Federal Occupational Health defines it as “the systematic assessment of employees exposed or potentially exposed to occupational hazards.” The Joint ILO/WHO Committee on Occupational Health defines occupational health surveillance as “a system which includes a functional capacity for data collection, analysis and dissemination linked to occupational health programs.” Some entities differentiate hazard surveillance from health surveillance—the former done largely by government regulatory agencies focusing on the workplace, ...