What is health surveillance?

Health surveillance is a system of ongoing health checks. These health checks may be required by law for
employees who are exposed to noise or vibration, ionising radiation, solvents, fumes, dusts, biological
agents and other substances hazardous to health, or work in compressed air.

Health surveillance is important for:

 detecting ill-health effects at an early stage, so employers can introduce better controls to
prevent them getting worse

 providing data to help employers evaluate health risks

 enabling employees to raise concerns about how work affects their health

 highlighting lapses in workplace control measures, therefore providing invaluable feedback to

the risk assessment

 providing an opportunity to reinforce training and education of employees (eg on the impact of
health effects and the use of protective equipment)

What is Health Surveillance?

Health Surveillance is a system of ongoing health monitoring. In the workplace, this is
undertaken with workers who have exposures that have known or suspected health risks. This is
sometimes also referred to as Biological Monitoring. Health surveillance is one of the last
components of hazardous substance management. It is designed to detect ill health effects in
workers at an early stage and allow employers to better controls to prevent the development of
disease. In short, it demonstrates whether the health substance management process is working.
It can also provide data to employers to evaluate workplace health risks.

Specific Health Surveillance Services

Resile regularly provides health surveillance services for a range of substances including:

 Crystalline Silica
 Isocyanates
 Lead
 Asbestos
 Any other hazardous chemical for which there is a valid test method for detecting health
effects or exposure

It is a legal requirement for employees who are exposed to specific hazardous substances to
undergo health surveillance. There are a number of substances requiring health surveillance
under various state legislation. To better understand the risks and requirements for health
surveillance for your organisation, contact Resile on 1300 737 453.
Crystalline Silica
Crystalline silica is one of the most abundant minerals in the earth’s crust. It is found in sand,
clay, gravel, and almost all types of rock including marble and granite. It is a major constituent
of bricks, tiles, granite, grout, mortar, bitumen and concrete and is found in high concentrations
in engineered stone used to fabricate kitchen and bathroom benchtops. So when a worker is
involved in cutting, grinding, sanding or polishing these materials there is a high risk of exposure
to crystalline silica.
Respirable crystalline silica particles are so small they cannot be seen by the naked eye and are
therefore easily inhaled deep into the lungs. Respirable crystalline silica particles also stay
airborne long after larger dust particles have settled to the ground. There can be serious health
consequences from exposure to respirable crystalline silica – Silicosis is an incurable lung
disease caused by inhaling respirable crystalline silica. It results in the formation of scar tissue in
the lung, leading to a loss of lung function and sometimes eventually to lung cancer.
The recent resurgence of Silicosis cases is a serious concern for all workers and employers. Strict
workplace safety processes, using the best health controls available, and proactive health
monitoring are required to prevent or reduce workers’ risks.
Exposed workers should undergo respiratory function testing, and radiological assessments need
to be performed to meet evidence-based standards.
Let Resile help you navigate this rapidly changing regulatory environment and ensure you have
robust workplace practices in place to protect your workers from silica dust.

Workplace health surveillance

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Occupational hazards

 Physical
 Chemical
 Biological
 Psychosocial
 Hierarchy of hazard controls

 Elimination
 Substitution
 Engineering controls
 Administrative controls
 Personal protective equipment
 Prevention through design

Occupational hygiene

 Occupational exposure limit

 Exposure assessment
 Workplace health surveillance
 Occupational epidemiology
 Occupational toxicology

 v
 t
 e

Workplace health surveillance or occupational health surveillance (U.S.) is the ongoing

systematic collection, analysis, and dissemination of exposure and health data on groups of
workers.[1][2] The Joint ILO/WHO Committee on Occupational Health at its 12th Session in 1995
defined an occupational health surveillance system as “a system which includes a functional
capacity for data collection, analysis and dissemination linked to occupational health programmes”.[3]
The concept is new to occupational health and is frequently confused with medical screening. Health
screening refers to the early detection and treatment of diseases associated with particular
occupations, while workplace health surveillance refers to the removal of the causative factors.

Medical surveillance[edit]

A video about medical testing at a workplace as part of a NIOSH Health Hazard Evaluation
Program investigation

The mission of a medical surveillance program is to keep workers healthy and ensure that
employers are meeting OSHA standards in health and safety.[4] Medical surveillance has an
emphasis on prevention: it is designed to detect potential workplace hazards before irreversible
health effects can occur.[5] Clinicians with expertise in occupational health, industrial exposures, and
respiratory protection screen workers with physical examinations, blood testing, spirometry (a
measurement lung function), and audiometry. Screenings are performed at set intervals, often
annually. The clinicians providing medical surveillance services include board-
certified occupational and environmental medicine physicians, mid-level practitioners, nurses, and
NIOSH-certified spirometry technicians.[4][5]
Medical surveillance targets actual health events or a change in a biologic function of an exposed
person or persons. Medical surveillance is a second line of defense behind the implementation of
direct hazard controls such as engineering controls, administrative controls, and personal protective
equipment. NIOSH recommends the medical surveillance of workers when they are exposed to
hazardous materials. The elements of a medical surveillance program generally include the
following:[6]

1. An initial medical examination and collection of medical and occupational histories

2. Periodic medical examinations at regularly scheduled intervals, including specific medical
screening tests when warranted
3. More frequent and detailed medical examinations as indicated on the basis of findings from
these examinations
4. Post-incident examinations and medical screening following uncontrolled or non-routine
increases in exposures such as spills
5. Worker training to recognize symptoms of exposure to a given hazard
6. A written report of medical findings
7. Employer actions in response to identification of potential hazards
When the purpose of a medical surveillance program is to detect early signs of work-related illness
and disease, it is considered a type of medical screening, to detect preclinical changes in organ
function or changes before a person would normally seek medical care and when intervention is
beneficial The establishment of a medical screening program should follow established criteria, and
specific disease endpoints must be able to be determined by the test selected.[6]
Medical examinations and tests are used in many workplaces to determine whether an employee is
able to perform the essential functions of the job. Medical surveillance of workers is also required by
law in the United States when there is exposure to a specific workplace hazard, and OSHA has a
number of standards that require medical surveillance of workers In addition to substance-specific
standards, OSHA has standards with broader applicability. For example, employers must follow the
medical evaluation requirements of OSHA’s respiratory protection standard (29 C.F.R. 1910.134)
when respirators are necessary to protect worker health. Likewise, the OSHA standard for
occupational exposure to hazardous chemicals in laboratories (29 C.F.R. 1910.1450) requires
medical consultation following the accidental release of hazardous chemicals. NIOSH also
recommends medical surveillance, including screening, of workers when there is exposure to certain
occupational hazards.[6]

Hazard surveillance[edit]
Hazard surveillance involves identifying potentially hazardous practices or exposures in the
workplace and assessing the extent to which they can be linked to workers, the effectiveness of
controls, and the reliability of exposure measures. Workplace hazards can be chemical, biological,
physical, ergonomic, psychosocial, or safety-related in nature.[7] Hazard surveillance is an essential
component of any occupational health surveillance effort and is used for defining the elements of the
risk management program. Critical elements of a risk management program include recognizing
potential exposures and taking appropriate actions to minimize them (for example, implementing
engineering controls, employing good work practices, and using personal protective equipment).
Hazard surveillance should include the identification of work tasks and processes that involve the
production and use of hazardous materials, and should be viewed as one of the most critical
components of any risk management program.[6]
Hazard surveillance includes elements of hazard and exposure assessment. The hazard
assessment involves reviewing the best available information concerning toxicity of materials. Such
an assessment may come from databases, texts, and published literature or available regulations or
guidelines. Human studies, such as epidemiologic investigations and case series or reports, and
animal studies may also provide valuable information. The exposure assessment involves evaluating
relevant exposure routes (inhalation, ingestion, dermal, and/or injection), amount, duration, and
frequency (i.e., dose), as well as whether exposure controls are in place and how protective they
are. When data are not available, this will be a qualitative process.[1]

Occupational Health Indicators (OHIs)[edit]

In 1998, the Council of State and Territorial Epidemiologists (CSTE) joined the CDC's National
Institute for Occupational Safety and Health (NIOSH) to form the Occupational Health Surveillance
Work Group in order to prioritize occupational health conditions to be placed under
surveillance.[8] The Work Group recommended that states use 19 occupational health indicators
based on the availability of easily obtainable statewide data, the public health importance of the
occupational health effect or exposure, and the potential for intervention activities.[8]
These indicators are useful in assessing the ongoing policies and preventive measures but they also
have some limitations. Among the major limitations are the underreporting of occupational health
disorders, the inability to recognize potential occupational association of the disorder by health care
workers, difficulties in attributing diseases with long latency or multiple causes (such as lung cancer)
to occupational exposures, exclusion of special populations (such as self-employed or military
personnel), and differences between state-specific databases.[8]

Data Sources[edit]
Data for the OHIs come from multiple sources including:

 Death certificates, with contributing and underlying causes of death, which all states send to
the National Vital Statistics System in CDC's National Center for Health Statistics
 Cancer registries, such as the North American Association of Central Cancer Registries
 State hospital discharge data
 State Worker's Compensation systems
 Occupational safety and health professionals
 Survey of occupational injuries and illnesses, with results provided in the Bureau of Labor
Statistics (BLS) Annual Survey of Occupational Injuries and Illnesses[9]
 BLS Census of Fatal Occupational Injuries[10]
 Poison Control Centers (PCCs), which submit real-time data to the American Association of
Poison Control Centers for inclusion in the Toxic Exposure Surveillance System[11]
 Adult Blood Lead Epidemiology and Surveillance (ABLES)[12]
 OSHA's Integrated Management Information System (IMIS), which maintains worksite inspection
data to determine compliance with health and safety standards[13]

Tools[edit]
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The usefulness of a surveillance tool may depend on what hazards are present in the workplace and
the health effects those hazards may cause. For example, hearing tests will be helpful when noise
exposures are present, while tests assessing lung function or biomonitoring may be useful when
airborne agents are present. It is also important to distinguish between tools using medical
surveillance (measuring health effects) and hazard surveillance/exposure assessment (physical
measurements of the type and severity of hazard present). Periodic testing, including a baseline
exam when an employee is hired, can often help detect a decline in function by comparing previous
results.

Hearing exam

Medical surveillance tools

 General
o Epidemiological cohort and case–control studies investigate associations between causative
agents and specific health effects.
o Physical examinations assess the overall well-being of the worker and identify health-related
issues.

 Chemical or particulate exposures

o Pulmonary function testing is a way to measure lung function. It can assist in the early
detection of occupational lung diseases and provides information about the severity and
staging of asthma and other restrictive lung diseases.[14][15][16]
 Spirometry tests measure how quickly air can be pushed out from the lungs and is
useful in evaluating diseases that cause obstruction to flow.[14]
 Plethysmography measures lung volume by having the subject perform breathing tests
inside of an air tight box.[14]
 Flow rates can be measured by asking subjects to blow air out of the lungs as fast and
as hard as possible from their largest inhaled breathe (inspiration) to the maximum
exhaled breathe (expiration). The volume exhaled in the first second is called the forced
expiratory volume in one second (FEV1). These flow rates can be indicators of disease
that cause obstruction to airflow, such as asthma, chronic bronchitis, and emphysema.[14]
o Biomonitoring measures total body burden of a hazardous chemical in a worker via analysis
of biological specimens such as urine or blood. Non-invasive procedures are preferred when
possible.[17]

 Noise exposures
 o Audiometry remains the mainstay of diagnosis of noise-induced hearing loss, which is the
most common reported occupational disease in all parts of the world.[18]

 Other
o Hand arm assessment[19](vibration) and dermatological assessments[20] (chemical) are other
important tools for workplace health su
To understand these two terms. First we should clear how these terms are employed in
the preventive science. Term Monitoring is one type of control of any programme, it is to
observe/ note the day to day activities, .So that the project /programme can run
according to the planning.If there is any deviation, which is bound to occur,if we not take
corrective measures timely, then it leads some problem during implementation of the
programme /Project.

Surveillance in simple words it is collection of data for action. This activity is mostly to
detect the undetected cases of any disease.When we get information through data
collection, then we diagnose problems or bottlenecks and try to act on the various
points through multipronged strategy, so that we contain disease which is a serious
public health problem.