Health Surveillance Program - Essay Example

Health Surveillance Program Health Surveillance Program Introduction According to the World Health Organization (2014), occupational health involves aspects of health and safety in the working places with emphasis on the prevention of hazards. As a major occupational healthcare discipline, it is concerned with enabling individuals in workplaces undertake their duties in a way that causes the least harm to their health by preventing an incidental hazards. Health is there in defined by the WHO as state of complete physical, mental as well as social well-being, and not just the mere absence of a disease. A joint ILO/WHO committee on work-related health indicates that the focus of an occupational health undertaking should be to maintain and promote workers health and working capacity and improve the working environment by making it conducive to safety and health (WHO, 2014). Additionally, it recommends that any working environment should be based on development of an organizational working culture, which promotes and supports health and safety; hence, promote a positive social climate and operation that enhances productivity. Health surveillance refers to systematic and regular procedures put in place by an organization to detect early signs of occupational health hazards among employees especially those exposed to possible health risk due to the nature of their work (Reese, 2003). It involves managing work effects on one’s health and seeking information necessary for ensuring that efficient control measures are put in place and need for further controls (Hse.gov.uk, 2014). In most countries including Australia, health surveillance as well as risk assessment is mandatory by law with every employer being required to reduce as a far as reasonably practicable the risks to health and safety of employees from their work activities (Repa, 2014). The most affected industries and required to undertake health surveillance are those whose employees are exposed to noise, vibration, ionizing radiation, fumes, biological agents, solvents and any other substances considered hazardous to health or work in compressed air. Occupational health and safety remains a major concern in Australia, a country considered among the leading economies of the world; hence, has a large workforce across the major industries and the informal sector. According to the data released by safe work Australia in the report “Work Related Traumatic Fatalities 2014, the country had 191 work related deaths in 2013 with the fatality rate among the self-employed being three times higher that of the employed (Safeworkaustralia.gov.au, 2014). Agriculture, forestry, fishing, transport, warehousing, and construction industries experienced the highest fatality rates arguably due to higher than average proportion of self-employed workers. Hazardous chemicals also remain a major concern for the Australian government. These are chemical substances and mixtures used in work places that can be classified as health hazards according to the health and physicochemical hazards. They include skin irritants, carcinogens, and respiratory sensitizers that have adverse effects of workers well-being on inhaling, ingesting or skin contact. The country has adopted a new national model work health and safety (WHS) regulations and a new system of chemical classification to try to reduce the health effects of the chemicals but the cases persist though at a reduced levels (Healthsurveillanceaustralia.com, 2014). Health Surveillance Requirements in Australia The National Occupational health and Safety Commission (NOHSC), a multilateral body established by commonwealth government develops the health surveillance requirements and guidelines in work places in Australia. The commission, which comprises of the peak employee representatives, state governments representatives and employer bodies such as Australian council of trade unions and the Australian Chamber of Commerce and industry, is charged with the responsibility of developing, facilitating and implementing the national occupational health and safety strategy. This strategy includes the development of work place standards, development of specific industry based preventive strategies, training, information collection, research, and advancement of approaches to work place health and safety legislation. The commissions National Model Regulations for the control of Work place hazardous substances [NOHSC: 2007(1994)] provide for a health surveillance as part of integrated measures aimed at controlling hazardous substances and ensure health and safety of employees. The model has differentiated elements described below. Purpose of health surveillance: Requires a health surveillance to be done to ensure that control measures being utilized in a specific firm or industry are effective and offer an opportunity to strengthen precise preventive measures deemed necessary for safe work practices. The Health surveillance shall include biological monitoring and should be aimed at minimizing risk to health due to exposure to hazardous substances (National Occupational Health and Safety Commission, 1994). It provides for a health assessment to confirm that the absorbed dose of the hazardous substance is below the accepted level, indicate the biological effects that may lead to cessation or reduction of exposure and collection of data to evaluate the effects of the exposure. The instituted code dictating national practices used in controlling work place hazardous substances further provides guidelines on the employees who may require health surveillance. This includes employees who the work place assessment has identified to be in a significant risk to health from any of the hazardous substances listed in the commission’s schedule 3. Employees also identified as exposed to hazardous substance for which an identifiable disease or health issue may be related and there exists a valid technique and biological monitoring procedure for detecting indications of this effects should also be subjected to health surveillance other the code. Responsibility for health surveillance: Under the code, an employer is charged with the responsibility of providing health surveillance and a work assessment process (National Occupational Health and Safety Commission, 1994). Expectations are placed on the registered practitioners on the supervision of the health surveillance process on being deemed necessary either directly or indirectly by supervising the surveillance program being carried out by other identified qualified personnel. However, the selection, coordination and supervision of the health surveillance by the health practitioner shall remain a responsibility of the employer in order to ensure consistent methods are used in the program. To avoid dissatisfaction and alienation concerns, the process, selection of registered medical practitioner inclusive should be done in consultation with the employees in order to give them a reasonable choice in selection a qualified occupational medical practitioner. Employer responsibilities: Clear guidelines have been included under sub-regulation 14 (6), where employers should pay any reasonable expenses accrued in the health surveillance such as medical fees, pathology tests, and travel expenses among others (National Occupational Health and Safety Commission, 1994). Furthermore, employers should ensure that the health surveillance results are retained as confidential for the purpose of national model regulations. Information transmitted to the employees of the need, purpose, and procedure for the health surveillance. Necessary and acceptable arrangements for the staffs to contribute towards the health surveillance program should be instituted. Allow the registered medical practitioner or occupational nurse unlimited access to associated assessment reports. Receipt of an adverse notice following an instituted health surveillance, the employer should take the necessary action as soon as possible to reassess the work place. He should also consequently provide all the appropriate controls to minimize further risk to health and safety of the employees. In a circumstance where the registered medical practitioner certifies that, an employee is unfit for further exposure to a specific hazardous substance or he recommends that the employee work only under certain conditions, the employer should adhere to such recommendations. This may include relocating the employee to a suitable location or changes of his work description to prevent further exposure. Efforts of relocation or associated changes in the description of work should follow a consultative route. Given that, the national commission may not be able review all work places for hazardous substances, the employer should consider if any other substances present in the work place present a significant risk to health. If established so, the employer shall then establish a health surveillance program in collaboration with the registered medical practitioner who will assist in assessing the need of the surveillance program and set up the appropriate health surveillance program. Responsibilities of an appointed medical practitioner: Under the sub-regulation 14 (11) of the code, the commission provides that the health surveillance be done by a qualified registered medical practitioner (National Occupational Health and Safety Commission, 1994). In a case where there exists no registered medical practitioner authorized by the relevant public authority, a medical practitioner shall be adequately trained to undertake the health surveillance program. The registered medical practitioner should have an understanding of the employees’ work activities and his or her duties under the national model regulations. This duties and responsibilities include the maintenance of all the medical records and ensure their confidentiality by clearly identifying and separating them from other records obtained for other purpose such as records of examination (Deir.qld.gov.au, 2014). In circumstances where the blood, tissue samples, x-rays, questionnaires or any other materials taken for the purpose of health surveillance should be used in other purposes other than the presupposed health surveillance, the registered medical practitioner shall seek express consent of the employee. Advise the employees of the health surveillance results and provide the necessary explanation, arrange for treatment, preventive measures, and rehabilitation (National Occupational Health and Safety Commission, 1994). Quality assurance: In the provision of health surveillance, the involved parties-the employer, employees, and the registered medical practitioner should ensure the quality of the program is within the acceptable quality assurance standards. The code stipulates that such standards shall meet the standards set out in the Standards Australia AS 3900-Quality Management and Quality Assurance Standards (National Occupational Health and Safety Commission, 1994). To ensure this, any specific tests required should be done an analytical laboratory accredited for the procedure by the National accreditation testing Authority. Chemicals that require health surveillance in Australia The National Commission under Schedule 3 of the National Model Regulations for control of workplace Hazardous substances [NOHSC: 1005 (1994] sets out the substances for which health surveillance is required together with the minimum requirements for the surveillance. The listed hazardous substances include acrylonitrile, asbestos, benzene, cadmiumcreosote, isocyanates, inorganic Chromium, inorganic mercury, Methylene bis 2- chloroaniline (MOCA), organophosphate pesticides, pentachlorophenol (PCP), inorganic arsenic, polycyclic aromatic hydrocarbon (PAH), crystalline silica, thallium, and vinyl chloride (National Occupational Health and Safety Commission, 1994). Establishing a new health surveillance program in a work place Employers are expected to identify the hazardous substances in line with the national commission’s National Model regulations for control of work place hazardous substances [NOHSC:1005(1994)] guidelines and criteria to establish a new health surveillance (Reese, 2003). The guidelines offers a series of questions intended to investigate variety of issues relating to health surveillances (Alli, 2008). Depending on whether the answer to the questions is yes/no or if it warrants a complete cyclical investigation then, the health surveillance program has to be established.The necessary steps to be followed in establishing the program include- Identifying existence of the substance: This is the initial stage where the employee is expected to ascertain the existence of the substance and its possible use in the future (Gallagher, Underhill & Rimmer, 2003). A check should be made to ascertain if the substance is listed in the Australian Inventory of Chemical substances to establish if it can be used without an assessment from the National Industrial Chemicals. A health surveillance program should be developed to guide its usage until if the substance in question is not in the list. Establishing if the substance is hazardous to health: This is determined using the national commission’s approved criteria of classifying hazardous substances. The commission’s regulations define a hazardous substance as a substance that has the potential of harming the workers’ health or safety. The criteria further specify the basis of classifying a substance as hazardous, which includes a detailed research and literature search on the substance (Alli, 2008). Establishing evidence of possible health injury: Once a substance is classified as hazardous, there is need to assess and establish whether it represents a risk to the workers done by considering a range of information about the population at risk. For instance, the number of people to be exposed, susceptible third parties and the range of exposure in terms of frequency and duration has to be identified (Schulte et al., 2008). The information is important in identifying the magnitude of the risk and whether the correct group is being targeted. Other considerations to be factored include the variability and effectiveness of the control of occupational exposure and the potential routes of exposure. Assessment of the exposure routes may range from inhalation and dermal absorption hence the physical characteristics of the substance, its toxicology and metabolism should be considered. Determining if Atmospheric monitoring can be sufficient in evaluating the possible effects: The employer in association with the licensed medical practitioners need to determine if an existing atmospheric monitoring system can adequately evaluate the effects of the substance (Choi, 2012). If affirmative, a conclusive assessment involving third parties should be done to fully ascertain if the atmospheric monitoring would be sufficient. Assessing if Health surveillance techniques are available for this substance: The National Commission defines health surveillance as the monitoring of individuals to identify changes in health due to occupational exposure to hazardous substance. This includes biological monitoring, systematic collection, analysis, and evaluation of health data in order to identify population trends and disease cases, which may suggest adverse effects and need for remedial action. Furthermore, health surveillance includes taking occupational history, physical examination, and laboratory tests. To identify if a health surveillance techniques for the given substance exist, methods such as determining if the surveillance is required by the state or determining if the biological exposure indices have been developed can be used Robson et al., 2007). These methods are then subsequently supported by detailed scientific literature and documented toxic kinetics. In cases where health surveillance techniques are identified, a test of validity and reliability should be done. A technique is considered valid for health surveillance if it has high sensitivity and specificity hence allowing a higher proportion as possible adversely affected by exposure to be detected (Koh & Aw, 2003). Nevertheless, no single technique can be said to be effective in health surveillance. An ideal health surveillance test should produce consistent results upon repeated testing depending on factors such as the imprecision of the test and intra-individual biological variation in the biochemical and physiological parameter under consideration. Additionally, to test for validity, the interpretation of results must be done to ascertain if they have meaning. A standard reference range should therefore exist to make comparisons easy and give the results intrinsic meaning. A valid health surveillance test should also be able to detect early adverse effects (Mason, 2014). Early detection allows for preventive measures at an early stage where the effect can be averted. Determining the benefit of health surveillance to those in risk: At this stage, two benefits are assessed- the individual and group benefit. For an individual, the benefit evaluated is whether there is an exposure level identified by the test that can be used to motivate the prevention of further exposure and progression of the adverse effect. Identification of this exposure level is critical, as it is the most important concern for health surveillance. In addition, through the surveillance, individuals get educated on how to reduce their risk hence ultimately benefit. Group wise, the health surveillance allows for evaluation of control measures, performance risk assessment for foreseen risks and evaluation of risk using epidemiological techniques. Apart from the individual and group benefits, the stage allows for assessment of the ability of the control measures to the employed to reduce the exposure levels. Determining if the chosen health surveillance methods would be acceptable by those in risk: The health surveillance technique has to be accepted by the individuals at risk. Acceptance evaluation in terms of personal convenience, attendant risk, side effects, and perceived personal value therefore has to be done because a surveillance test, which is considered inconvenient, represents a risk, is not perceived advantageous to an individual, and may in the future alienate some workers hence affecting its uptake (Robson et al., 2007). Determining if the health surveillance method is practical and ethically acceptable: This stage is considered the final stage in phase one of developing a health surveillance system. It seeks to ascertain whether those involved in the monitoring can accomplish the test in a feasible manner and if the results established are effective and interpretable. Considering the substance for health surveillance program: If a substance satisfies all the above questions and stages, then the process enters the second phase under which the health surveillance program is formulated and initiated (Jamison et al., 2006). This involves the monitoring of the occupational hazard for prevention and development of specific guidelines. Extensive scientific literature and investigation focusing of the details of developing the health surveillance program is subsequently completed to facilitate development and evaluation of the program to be set up. The chosen program should be unique to the demands of the workplace and should further be reviewed regularly to maintain its quality and appropriateness. According to NOHSC: 2007(1994), the employer is charged with responsibility of facilitating the above stages and the general assessment for health surveillance but on deeming the program necessary, the expertise of a registered medical practitioner responsible or the supervision of the program has to involved. The selection of the registered medical practitioner selection however has to be in consultation with the employees concerned in to give the employees a reasonable choice. In case the above stages are equivocal, scheduling for health surveillance may not be very appropriate. However, the health surveillance should be monitored as dynamics of the substance may change warranting for scheduling of health surveillance. Setting up a Health Surveillance program for Asbestos Asbestos forms one of the most common occupational carcinogen and hazard given its substantial risk for the development of cancer (NOHSC, 1994). Plumbers, pipefitters, insulation workers, construction workers, welders, cement, and metalworkers all have a significant asbestos exposure (Safeworkaustralia.gov.au, 2014). Asbestos is associated with a number of illnesses including pulmonary parenchymal fibrosis disease, thoracic cancer, bronchogenic and ovarian carcinomas, pleural fibrosis, asbestomas, among many others. Proper health surveillance is critical in the prevention of asbestos adverse effects by implementing effective control measures. The Australian safety and Compensation council (ASCC) outlines that exposure to airborne asbestos should be restricted to as practically possible below the mandated exposure standard of 0.1 fiber per milliliter of air (National Occupational Health and Safety Commission, 1994). Development and maintenance of the health surveillance system for asbestos should therefore involve frequent respirable fiber air measurement by occupational hygienist and identification and assessment of the friability of the asbestos materials. Three types of monitoring of are important in developing the health surveillance system. First, the employer has to undertake an occupational monitoring to measure the airborne respirable fibers in the workers breathing zone in comparison with the exposure standards of 0.1 fibers per militre of air (Reese, 2003). Secondly, the employee should undertake control monitoring in which the controls put in place are assessed to establish if they are adequate in maintaining a healthy working environment. Subject to the finding, the control measure may be retained, reviewed, or abandoned. Finally, the employee must maintain a clearance monitoring of every asbestos removal work in which a clearance certificate completed by an occupational hygienist is issued. The ASCC Guidelines for Health Surveillance sets out the minimum requirement for health surveillance for those workers exposed to asbestos. It outlines that medical examinations are to be carried out regularly on the workers by a work cover authorized medical practitioner and compels employees to keep record of exposure to asbestos. The records should be structured in a way that the significance of various signs is easily identifiable to prompt relevant action. These records should then overtime be used to provide statements to employees on termination of their employment, which clearly recommend for regular health assessments and details of relevant health tests to be undertaken. Further, the employers have to maintain an exposure register outlining the name of the exposed, the date, and location of exposure and type of work being carried out during the exposure. How health surveillance complement occupational hygiene Hygiene is perceived as the anticipation, recognition, and control of health hazards in a working environment with an aim of protect the employees’ health and well-being (Repa, 2014). It constitutes the prevention of ill health in working places through identifying, evaluating and controlling occupational risks. Occupational hygiene requires rigorous scientific research and methodologies, professional judgment based on experience and education. It requires risk management, exposure management, and safety assessment with goal of preventing occupational disease. Health surveillance therefore complements occupational hygiene by providing the framework to monitor, evaluate, and blend professional experience for safe work places (Koh & Aw, 2003). Additionally, health surveillance determines the possible exposures and hazards allowing occupational hygienists to develop controls aimed at reducing the health risks by using toxicological, epidemiological and medical data. Conclusion Taking steps aimed at improving health and well-being of workers in the job environment not only increases safety performances, but also the productivity and work place culture. It improves the work organization and working environment consequently increasing workers participation in shaping the job environment and encourages professional skills development. To the employers, proper health surveillance and managements increases their productivity, improves their engagement and staff morale, reduces absenteeism, increases retention, reduce injury and compensation costs, improved corporate image among other benefits. The employees on the other hand enjoy improved health awareness and knowledge, show improved energy, vitality, and resilience, enjoy work more and fill fulfilled, improve their productivity and concentration and increase team productivity. Health surveillance is the systematic and regular procedures put in place by an organization to detect early signs of occupational health hazards among employees especially those exposed to possible health risk due to the nature of their work. It involves managing effects of work effects on one’s health and seeking information necessary for ensuring that effective control measures are implemented and need for further controls. Law in most countries s mandate employers to conduct a work place assessment to identify the possible risks to their employees after which they engage the medical practitioners and develop relevant guidelines and procedures to monitor, evaluate, and control those risks. Occupational risks are however dynamic; hence, a heath surveillance and adoption of different solution strategies should be continuous and regular to meet the changing needs. References Alli, B. (2008). Fundamental principles of occupational health and safety (1st ed.). Geneva: International Labour Office. Choi, B. (2012). The Past, Present, and Future of Public Health Surveillance. Scientifica, 2012. Deir.qld.gov.au,. (2014). Benefits of work health initiatives - Workplace Health and Safety Queensland. Deir.qld.gov.au. Retrieved 28 August 2014, from http://www.deir.qld.gov.au/workplace/workers/healthy-workers/benefits/index.htm#.U_tj0aOSPy8 Gallagher, C., Underhill, E., & Rimmer, M. (2003). Occupational safety and health management systems in Australia: Barriers to success. Policy And Practice In Health And Safety, 1(2), 67-81. Healthsurveillanceaustralia.com,. (2014). Occupational Surveillance Programmes. Healthsurveillanceaustralia.com. Retrieved 28 August 2014, from http://www.healthsurveillanceaustralia.com/occupational-surveillance-programmes.html Hse.gov.uk,. (2014). HSE: What is health surveillance?. Hse.gov.uk. Retrieved 28 August 2014, from http://www.hse.gov.uk/health-surveillance/what/index.htm Jamison, D., Breman, J., Measham, A., Alleyne, G., Claeson, M., & Evans, D. et al. (2006). Public Health Surveillance: A Tool for Targeting and Monitoring Interventions. World Bank. Koh, D., & Aw, T. (2003). Surveillance in occupational health. Occupational And Environmental Medicine, 60(9), 705. Martini, A., Iavicoli, S., & Corso, L. (2013). Multiple chemical sensitivity and the workplace: current position and need for an occupational health surveillance protocol. Oxidative Medicine And Cellular Longevity, 2013. Mason, J. (2014). Protecting staff with workplace health surveillance - Personnel Today. Personnel Today. Retrieved 28 August 2014, from http://www.personneltoday.com/hr/protecting-staff-with-workplace-health-surveillance/ National Occupational Health and Safety Commission,. (1994). GUIDELINES FOR HEALTH SURVEILLANCE [NOHSC:7039(1994)]. Canberra: Australian Government Publishing Service,. Reese, C. (2003). Occupational health and safety management (1st ed.). Boca Raton, Fla.: Lewis Pub. Repa, B. (2014). Your rights in the workplace (1st ed.). Berkeley, Calif: Nolo. Robson, L., Clarke, J., Cullen, K., Bielecky, A., Severin, C., & Bigelow, P. et al. (2007). The effectiveness of occupational health and safety management system interventions: a systematic review. Safety Science, 45(3), 329-353. Safeworkaustralia.gov.au,. (2014). Hazardous chemicals - Safe Work Australia. Safeworkaustralia.gov.au. Retrieved 28 August 2014, from http://www.safeworkaustralia.gov.au/sites/swa/whs-information/hazardous-chemicals/pages/hazardous-chemicals-other-substances Schulte, P., Trout, D., Zumwalde, R., Kuempel, E., Geraci, C., & Castranova, V. et al. (2008). Options for occupational health surveillance of workers potentially exposed to engineered nanoparticles: state of the science. Journal Of Occupational And Environmental Medicine, 50(5), 517-526. WHO,. (2014). WHO | Workplace health promotion. Who.int. Retrieved 28 August 2014, from http://www.who.int/occupational_health/topics/workplace/en/index1.html Read More