Guidelines On Medical Surveillance

3 Risk of Cancer from the use of Tar,

6.2 MEDICALLY REMOVED WORKERS
& RETURN TO WORK
All medically removed workers
should have repeat investigations
and relevant biochemical tests within
one month.
The worker should not return to work
until the signs and symptoms and
abnormal cytology/ biochemical
results have disappeared.
Recommend the worker for return to
Bitumen in Road Works. Br J Ind M.ed,
46:1,24-30, 1989. 6.14.3.
4 Control of Substances Hazardous to
Health (COSHH) Regulations 11-
Health Surveillance- carbonaceous
agents associated with skin cancers in
HSF, 1989.
34. VINYL CHLORIDE MONOMER

work when the workplace hygiene (VCM)

is safe and healthy and does not

1.0 SYNONYMS: Cholroethylene
place the worker at increased risk of
PEL 8hr TWA: 1 ppm
material impairment to health from
Route of entry
exposure to pitch, tar, bitumen &
creosote. Inhalation, skin

7.0 PREVENTIVE MEASURES 2.0 OCCUPATIONS AT RISK OF

Workers at risk should be made EXPOSURE
aware of the dangers of the (Production of polyvinyl chloride
substances they are handling resins (workers who clean and
The employer should be maintain the reactors are especially
encouraged to examine their skin at risk)
regularly and report any suspicious
Storage of VCM
lesions to the OHD.
Appropriate signage Sampling and analysis of VCM

3.0 TOXIC EFFECTS

8.0 REFEERNCES
1 International Labour Office: 3.1 ACUTE EFFECTS

Encyclopaedia of Occupational Health • Non-specific manifestations e.g.

and Safety, Geneva, 3rd edition, p headache, giddiness, disorientation.
569-570, 198-200, 1983: 2147-2149. • May progress to loss of
2 International Agency for Research on consciousness.
Cancer. Annual Report, World Health
• Lung irritation
Organisation, 1983: 39.
• Skin irritation

Department of Occupational Safety and Health (DOSH) Malaysia 115

 Guidelines On Medical Surveillance

3.2 CHRONIC EFFECTS 4.2 PERIODIC MEDICAL

• Raynaud' s phenomenon EXAMINATIONS

• Scleroderma-like lesions Should cover the same areas as the pre-

employment examination. An annual check
• Acro-osteolysis (especially of the
is appropriate.
hands)
• Liver and/or spleen fibrosis 4.3 WHERE INDICATED, THE
FOLLOWING TESTS MAY BE
• Lung fibrosis
DONE
• Pancytopenia
♦ Ultrasound

♦ Liver Scan

♦ Hand X -ray, to obtain baseline

• Others evidence of the state of the finger
• Angiosarcoma of the liver bones

♦ Chest X-ray
4.0 MEDICAL SURVEILLANCE
PROGRAMME ♦ Liver biopsy

Any occupational exposure to VCM. ♦ Platelet count

4.1 PRE-PLACEMENT MEDICAL ♦ Hepatitis screening

EXAMINATIONS 5.0 INDICATIONS MEDICAL REMOVAL

Clinical examination and baseline data with
special attention to detecting pre-existing
abnormalities of the liver, spleen, skin and
circulation to extremities (hands.)
♦ Liver function tests (Serum bilirubin,
alkaline phosphatase, alanine and
aspartate transaminases and
gamma-glutamyl transpeptidase
estimations)
♦ Pulmonary Function Test
Worker should abstain from alcohol at least
1 week prior to undergoing the liver
function tests.
PROTECTION
All cases of definite or suspected VCM
diseases
Workers with the following conditions: -
Persistent liver abnormalities (one or
more abnormal result in the liver
function test on at least 2 occasions
within a 1 month period).
Clinical evidence of liver disease e.g.
enlarged spleen, liver, spider naevi,
etc.
All cases recommended for MRP and
suspected cases of VCM diseases must be
notified to the DG (DOSH).

6.0 FOLLOW-UP ACTION

Department of Occupational Safety and Health (DOSH) Malaysia 116


Repeat tests.
6.1 ABNORMAL LFT RESULTS (one or
more parameters)
Cases with abnormal liver function test
results should be investigated to exclude
effects due to VCM. Please refer to the
algorithm on page 3 (ALGORITHM FOR
THE INVESTIGATION OF ABNORMAL
LIVER FUNCTION TEST RESULTS).
6.2 MEDICALLY REMOVED WORKER
& RETURN TO WORK
All suspended cases should be
followed up.
All removed cases should have repeat
liver function test at 3 monthly
intervals.
The worker may return to work with
VCM when the liver function results
return to normal and he is clinically
asymptomatic.
Recommend the worker for return to
work when the workplace hygiene is
safe and healthy and does not place
the worker at increased risk of
material impairment to health from
exposure to vinyl chloride.
7.0 PREVENTIVE MEASURES
Improvement in work-process
workplace hygiene Adequate
ventilation
Personal Protective equipment.
Chemical goggles
Workers should be advised to abstain
from alcohol
Appropriate signage
Department of Occupational Safety and Health (DOSH) Malaysia
Guidelines On Medical Surveillance
8.0 REFERENCES
1. International Labour Office:
Encyclopaedia of Occupational
Health and Safety Vol II, -2258, 1983:
22:56.
2. National Institute for Occupational
Safety and Health: Technical
Information. A cross-sectional
epidemiological survey of vinyl
chloride workers. U.S. Department of
Health, Education and Welfare1977:
No 77:177.
3. Makk, L; et al: Liver damage and
Angiosarcoma in vinyl chloride
workers -A systematic detection
program. Journal of the American
Medical Association, 1974.
4. Smulevich, 'V .B, I. V Fedotova, V .S.
Filatova: Increasing evidence of the
rise of cancer in workers exposed to
vinyl chloride. Br J Ind Med,
1988,45:2; 93-7.
5. Reinl, W H. Weber: Status of
epidemiological research of vinyl
chloride disease. ZeIJltralblatt fur
Arbeitsmedizin Arbeitsschutz and
Prophylaxe, 197:497- 104.
6. Roland S E Chong .An update on
&
Occupational Liver Disease. J Occup
Medicine, Vol 2, No 2, July 1990:44-9.
7. Donald S Herip: Recommendations for
the investigation of abnormal hepatic
function in asymptomatic workers. Am
J Ind Medicine, 21: 1992: 331-9.
117
 Guidelines On Medical Surveillance

8. Phoon WH, Magdalene Chan, Ho SF,

Dept of Industrial Health Guidelines
For Designated Factory Doctors-The
Factories (Medical Examinations)
Regulations Dept of Community,
Occupational and Family medicine
National University of Singapore
1997:36.1-361-5.

9. Control of Substances Hazardous to

Health (COSHH) Regulations:
Regulation 11-Health Surveillance-
Vinyl chloride in The Health and Safety
Factbook Health & safety Executive,
Professional Publishing Ltd London,
1989:1/9.

Department of Occupational Safety and Health (DOSH) Malaysia 118

 Guidelines On Medical Surveillance

ALOGRITHM FOR THE INVESTIGATION OF ABNORMAL LIVER FUNCTION TEST

RESULTS

> 1 parameter raised and/or at least

1 parameter > 10% of the upper
limit of laboratory's range

Repeat abnormal
Parameter(s) in 2
weeks time

Parameter(s) <10% At least 1 parameter

upper limit > 10% upper limit

Temporary suspension
for 3 months. Repeat
abnormal parameters

No suspension Parameter At least 1 parameter

Fit for work < 10% upper > 10% upper limit

Hepatitis Screening Test

and ultra-sound test of
liver and spleen

Continue with
annual
examination Normal Abnormal ultra sound
and/or HbsAg positive

continue suspension
and review results
3 monthly
PERMANENT
SUSPENSION

LFT still abnormal

after 1 year of
suspension

Department of Occupational Safety and Health (DOSH) Malaysia 119