MEDICAL SURVEILLANCE

Objectives
• Discuss medical surveillance & biological
monitoring as strategies in examining health
conditions of workers

• Explain the role of these strategies in preventing

occupational illnesses

• Describe the different steps in conducting medical

surveillance

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Purpose of Medical Surveillance

• Primary
o Prevention of illness
▪ Aims of OH

• Secondary
o Early detection of work-related health problems &
determining its cause

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Monitoring
• Ambient/environmental monitoring
• Biological monitoring
o Tool to assess systemic exposure & reflects absorption
by all routes, i.e., inhalation, ingestion, or through skin
contact (Hunter’s Dses of Occup, 10th ed)

• Medical surveillance
o Analysis of health information to look for problems that
may be occurring in the workplace that require targeted
prevention (OSHA, n.d.)

o Periodic clinical examination of workers designed to

protect their health through the early detection of
adverse effects & intervention to prevent further harm,
& complements biological monitoring (Hunter’s Dses of Occup, 10th ed)

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Monitoring
Ambient Monitoring Biological Monitoring Medical Surveillance
• Measurement & • Measurement & • Periodic medico-
assessment of agents at assessment of agents or physiologic exam of
the workplace their metabolites either in exposed workers
• Evaluates ambient tissues, secretions, • Aims to protect health &
exposure compared to excreta, expired air, or prevent work-related
reference any combination diseases
• TLV (Threshold Limit • Evaluates exposure
Values) compared to reference
• BEI (Biological Exposure
Index)

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Monitoring
• Data provide trends or emerging patterns in
workplace hazards & illnesses

• Followed by preventive action (appropriate control

measures) & evaluation of the effectiveness of
intervention

• Conducted to meet regulatory requirements

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Levels of Prevention

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Levels of Prevention

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 Exposure-Disease Paradigm

(Adapted from Hunter’s Dses of Occup, 10th ed)

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 Why conduct medical
surveillance?
• Worker population is not homogenous
• Monitoring of certain high risk groups
o New workers
o Workers returning after illness or injury
o Workers with concurrent condition that can be adversely affected
by workplace hazards
o Workers exposed to very hazardous substances or work processes
• When diseases in question are associated with particular
exposure or industry
• Hazard level within safe or acceptable limits don’t guarantee
that workers won’t be affected
• Meet regulatory requirements

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Steps in Surveillance of Occupational
& Work-Related Diseases
1. Hazard & exposure assessment
2. Identification of adverse health outcomes for
each hazard
3. Selection of medical screening tests
4. Interpretation of data & recommendation
5. Communication of results
6. Documentation/records keeping
7. Evaluation of control measures

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 1. Hazard & exposure
assessment

• Types of substances
• Processes involved
• Exposure pathways
• Exposed population
• Estimate intensity,
frequency, & duration
of exposure to toxic
agent

(Photo credits: OSHC, 2000)

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2. Identification of adverse health
outcomes for each hazard
Target Organ System
Industry/Process Hazard
(Possible Health Effects)
Mining Lungs (pneumoconioses)
Inorganic dust
Construction
Eyes & skin (irritation)
Respiratory system (irritation)
Agriculture Pesticides Nervous system (nausea,
e.g., malathion
vomiting, dizziness, convulsions,
coma, death)
Nervous system (dizziness,
Printing Toluene headache, euphoria)
Skin (dermatitis)
Musculoskeletal system
Stevedoring Lifting
(WMSDs)
Ears (Noise Induced Hearing
Garments/sewing Noise
Loss)
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Chemical Hazards & Their
Adverse Health Outcomes
Inhalation, Accidental ingestion, &/or
skin contact

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3. Selection of Medical Screening
Tests
Hazard Health Risk Test
Noise Noise-induced hearing loss Audiometry

Toluene • Nervous system • Neuro examination

• Liver • Liver profile
• Biological monitoring (urinary
toluene)

Silica Silicosis • Chest x-ray

• PFT
Asbestos Asbestosis • Chest X-ray
• PFT
Lead • Anemia • Neuro examination
• Nephropathy • Biological monitoring (lead in
blood)

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Selection of Medical Screening Tests
Medical screening
• Clinical in focus
• One source of medical data
• Detection and treatment of
actual disease
• No analysis of data because
deals with individual
16
Medical surveillance
• Preventive in focus
• Monitor results of screening
• Systematic continuous,
repetitive health-related
activities that should lead to
corrective action
• Group experience – analysis
of pattern of illness in a
target population
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 Schedule of Biological Monitoring
Tests for Selected Substances
Assay
Substance Parameter Sampling Time
Material
Benzene Urine • s-phenylmercapturic End of shift
acid/g-creatinine
• t,t-muconic acid/g-
creatinine
Hexane Urine 2,5-hexanedione End of shift at end
of workweek
Lead & its Blood Lead Not critical
compounds (except
alkyl lead
compounds)
Mercury, elemental Urine Mercury Prior to shift
Toluene Urine o-cresol/g-creatinine End of shift
Urine Toluene End of shift
(Adopted from ACGIH, 2018)
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 Schedule of Biological Monitoring
Tests for Selected Substances
Assay
Substance Parameter Sampling Time
Material
Acetone Urine Acetone/l-urine End of shift
Styrene Urine Mandelic acid End of shift
Xylene Urine Methylhippuric acid/g- End of shift
creatinine

Trichloroethylene Urine TCA/l-urine By the end of the

last shift of a
workweek/shift
period

Cadmium & its Blood Cadmium/g-creatinine Not critical

inorganic
compounds
(Adopted from ACGIH, 2018)
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 4. Interpretation of Data &
Recommendation
Periodic Exam Periodic Exam Periodic Exam Periodic Exam Periodic Exam

Course of Employment

Pre-Employment Exit/Separation
Exam Exam
Medical Surveillance Data = Basis of OH policies & programs
• Are workers still healthy?
• What control measures would you recommend based on these
results?
• Are your control measures effective in keeping your workers healthy?

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5. Communication of Results

Medical Surveillance
… … • Feedback of workers’
health exam results
Communicate to the OSH • Medical confidentiality
Committee o Using cases & statistics
• Facilitates continuous review rather than names of
of preventive programs
• Provides a mechanism for the workers
continuously improving OSH
performance
• OH policies & programs
based on the results (e.g.
top illnesses of the
company)

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6. Documentation/Records
keeping
• Medical records keeping
o Worker’s medical, occupational history, and Physical
examination results, diagnostic test results, interpretation,
records of notification, AMR

• Exposure evaluations
o WEM, biological monitoring

• Resulting environmental modifications

o Control measures implemented

• Requirements, procedures, & interpretation of findings

for medical surveillance as specified by national
legislation (e.g. TLVs)
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7. Evaluation of Control
Measures
• Do workers get sick in spite of control measures
being implemented?
• Are your control measures effective in keeping your
workers healthy?
60 60
55 55
50 50
45 45
40 40
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
1995 96 97 98 99 2000
asthma Low back pain
Cases of BA & LBP in Company X, 1995-2000 (HCD, 2019)
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BEI & WEM of Lead among
Workers in AC/DC Co., 2016-2019
BEI
Worker (μg/dL)
2016 2017 2018 2019
Juan Nyebe 48.0 46.8 26.5 21.8
Harry Palayok 45.2 43.2 41.2 40.9
Pedro Liuasan 15.3 19.7 15.3 13.6
Lucio Cayumangi 21.7 15.7 13.7 11.9
Dario Biñag
Best
Bash 19.6 16.3 11.6 9.4
Jack Maya 49.2 47.6 45.5 44.8
WEM
Reference values: (mg/m³)
• TLV for 8-hr exposure = 0.15 mg/m³
2016 2017 2018 2019
• BEI = 40 μg/dL
0.21 0.18 0.15 0.01
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 Rule 1960: Occupational Health
Services
• Occupational Health Program:
• Health examinations: Entrance, Periodic.
Special, Transfer and Separation
• Immunization Program
• Health Education and Counseling
• Health records maintenance

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24 OCCUPATIONAL SAFETY AND HEALTH CENTER
 Occupational Health
Services
1. Identification and assessment of health hazards

2. Surveillance of the factors in the working

environment and working practices, including
sanitary installations, canteens, and housing
where these facilities are provided by the
employer;

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25 OCCUPATIONAL SAFETY AND HEALTH CENTER
 Occupational Health
Services
3. Advice on planning and organization of work,
including the design of the workplace, on the
choice, maintenance, and condition of machinery
and other equipment, and on substances used in
work;

4. Participation in the development of programs for

the improvement of working practices as well as
testing and evaluation of health aspects of new
equipment;

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26 OCCUPATIONAL SAFETY AND HEALTH CENTER
 Occupational Health
Services
5. Advice on occupational health, safety and
hygiene, and an ergonomics and individual and
collective protective equipment;

6. Surveillance of workers’ health in relation to

work;

7. Promoting the adaptation of work to the workers

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27 OCCUPATIONAL SAFETY AND HEALTH CENTER
 Occupational Health
Services
8. Collaboration in providing information, training, and
education in the fields of occupational health and
hygiene and ergonomics;

9. Organizing of first-aid and emergency treatment;

10. Participation in analysis of occupational accidents

and occupational diseases

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28 OCCUPATIONAL SAFETY AND HEALTH CENTER
 Rule 1960: Occupational Health
Services
• Health Programs shall include:
• Entrance
• Periodic
• Special examination
• Transfer examination
• Separation examination

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29 OCCUPATIONAL SAFETY AND HEALTH CENTER
 Medical Surveillance
Know the hazard - How worker is affected
- How worker is exposed
Characterize the hazard - Exposure levels
- Exposure duration
Know the worker - Susceptibilities
Obtain information on - Directed towards affected
appropriate medical organ system
examinations
Analyze medical data - Disease, recovery,
rehabilitation

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30 OCCUPATIONAL SAFETY AND HEALTH CENTER
 Key Elements
of the Occupational Health
Program

• Health Promotion
• Health Protection
• Health Rehabilitation

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Health Promotion
• One of the key elements of the OH Program
• Health promotion is the process of
enabling people to increase control over,
and to improve, their health.

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Health Promotion
• Smoking cessation
• Reduced harmful use of alcohol
• Exercise
• Proper Diet
• Responsible sexual behavior

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Health Protection
• Definition
• health protection would include safeguarding
people from all hazards to health
• preventing hazards is a key element of health
protection.

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Health Protection
• Goals
• to provide medical screening to detect work-
related illnesses at an early stage when
medical intervention may be helpful.
• to help workers determine if a current health
condition is the result of a work-related
exposure.

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Health Protection
• Health Surveillance: OSHS Rule 1961.03 (h)
• Entrance
• Periodic
• Special
• Transfer
• Separation

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Health Protection
• Diagnosis and treatment of all injuries and
occupational and non-occupational
diseases
• Accurate and complete medical records of
each worker
• Immunization
• OSHS, RULE 1960

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Health Protection
• Submission of administrative requirements
• Annual Work Accident/Illness Exposure Data
Report (DOLE/BWC/OHSD/IP-6b)
• Annual Medical Report (DOLE/BWC/HSD/OH-
47-A)

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Health Protection
• Health education and counseling
• Health hazards and proper precautions, safe
work practices, use and maintenance of
available personal protective clothing and
devices, and use of available health services
and facilities

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 DOLE Issuances
Title Scope Components
Department Order No. 53-03: Mandatory for A.Advocacy,
Guidelines for the Implementation of a companies with 10 or Information,
Drug-Free Workplace Policies and more workers to Education and
include supply chain
Programs for the Private Sector Training
B.Preventive
Department Order No. 73-05: All workplaces in Strategies
Guidelines for the Implementation of the private sector C.Social Policy
Policy and Program on Tuberculosis including their D.Health Care
(TB) Prevention and Control in the supply chain Services
Workplace E.Benefits and
Compensatio
Department Order No. 102-10: n
Guidelines for the Implementation of F.Monitoring
HIV and AIDS Prevention and Control in and
the Workplace Program Enforcement
Department Advisory No. 05-10:
Guidelines for the Implementation of a
Workplace Policy and Program on
Hepatitis B
Health Rehabilitation
• Definition
• The process of restoration of skills by a person
who has had an illness or injury so as to regain
maximum self-sufficiency and function in a
normal or as near normal manner as possible.

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Health Rehabilitation
• DOLE-Employees’ Compensation Program
• Presidential Decree 626
• Income benefits
• Medical benefits
• Disability benefits
• Rehabilitation services
• Death benefits

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Solving Occupational Health
Problems
Identify hazards

Evaluate hazards

Prioritize problems

Select intervention

Implement intervention

Monitor effectiveness of intervention

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Participatory approach
• Participation and involvement from
stakeholders
• Coordinated intervention
• Learning from
• specifications/guidelines,
• scientific data
• best practice

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Summary
• Medical surveillance & biological monitoring are
strategies done to check for any abnormalities in
the body
• Monitoring activities has to be followed by
preventive interventions & post-evaluation of its
effectiveness
• Steps in conducting medical surveillance
• Collaborative role of SOs in the prevention &
control of occupational & work-related illnesses

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 Department of Labor and Employment
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