Nanotech: Elements of a Medical Surveillance Program

Guidance expected to be issued soon by the National Institute for Occupational Safety and Health (NIOSH) will recommend that all nanotechnology workplaces implement an occupational health surveillance program.

Earlier this month at the International Conference on Nanotechnology Occupational and Environmental health and Safety in Cincinnati, Doug Trout of NIOSH summarized NIOSH's upcoming guidance and provided a general overview of the topic of occupational health surveillance.

Trout noted that the upcoming NIOSH guidance will advise nanotech employers to conduct their surveillance programs "in a stepwise fashion," beginning with a needs assessment.

"The purpose of this needs assessment in an occupational setting is to determine – by performing hazard and exposure assessments – whether a health risk due to occupational exposure [to nanomaterials] exists in the workplace," Trout said.

If the needs assessment results in a determination that a health risk is present, Trout said, then employers should consider medical surveillance.

In part two of this two-part series, Trout details the factors that should be considered before implementing a medical surveillance program and discusses a template for a medical surveillance program that Trout said employers could implement "as a precautionary measure."

Define Objective; Identify Target Population

According to Trout, there are several factors that should be considered before implementing a medical surveillance program. "Evaluation of these factors," Trout explained, "is the foundation for the development of medical surveillance programs."

Before going forward with a medical surveillance program, nanotech businesses should:

  • Come up with a "clearly defined purpose or objective" for the surveillance. "For example," Trout said, "medical surveillance performed using periodic medical history data collection or questionnaire information might have, as a primary purpose, early detection of unusual patterns of symptoms or illnesses related to a particular organ system, or detection of changes in symptoms or medical conditions in individuals over time."
  • Identify the target population. "Such a population might generally include, for example, that subset of workers with the highest potential for exposure," Trout said.
  • Consider the availability of testing modalities. "Testing modalities – which may include tools such as questionnaires, physical examinations or medical testing – must be available to accomplish the defined objective," Trout said.

"If the factors considered in the planning stages noted above support proceeding with the development of a medical surveillance program," Trout explained, "a clear plan should be established before the program is initiated."

Basic Elements of a Medical Surveillance Plan

According to Trout, a medical surveillance plan should include provisions for:

  • Interpretation of that data that are collected;
  • Presentation or communication of the data findings to workers and management in the effected workplaces; and
  • Implementation of other steps of a complete medical surveillance program, such as planning for interventions and program evaluation.

Because of the dearth of information regarding the health effects of exposure to nanomaterials, Trout noted that "the application of specific medical testing modalities to nanotechnology workers may be poorly understood, such that those tests may not be appropriate for surveillance purposes."

Nevertheless, Trout asserted that conducting medical surveillance still might be prudent in such cases "to protect workers' health."

"Such medical surveillance could consist of, for example, collection of medical history information – possibly in the form of a focused medical interview or periodic questionnaire administration – on a population targeted by greatest likelihood of exposure," Trout said.

Before going forward with data collection as part of a medical surveillance program, Trout explained that EHS practitioners should consider these factors:

  • It would be important to have baseline information to assist in interpretation of the data;
  • Practitioners should keep an eye out for the elevated presence of common diseases or common symptoms that warrant follow-up investigation; and
  • "Information related to non-specific symptoms or health endpoints should not be collected without considerable thought as to how those data would be interpreted and particularly with the difficulties interpreting those data might present."

Program Manager Needed

For an occupational health surveillance program to be successful, Trout said that it needs to be coordinated by a program manager.

It is the program manager's responsibility to integrate the hazard assessment, exposure assessment and medical surveillance components of an occupational health surveillance program and to provide "input to the decision-makers of the organization concerning workplace safety and health."

"This integration and the need for program managers may be required at multiple levels," Trout added. " … For example, individual departments or duties – such as industrial hygiene or medical duties – within a single facility require coordination.

"On a broader scale, multiple facilities within the same organization also require coordination for the overall program to be effective."

This is part two in a two-part series on Trout's discussion of the upcoming NIOSH guidance for nanotechnology workplaces. To read part one – "Nanotech: NIOSH to Issue Guidance for Employers" – click here.

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