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Prepared by: Amalina & Ikhwan

 CONTENTS

• Introduction
• Legal provision
• Medical surveillance
• component
• Responsibilities
• Example: Asbestos
• References
• Video 2
 INTRODUCTION

• Malaysia is taking a great steps to be an industrialized

country by the year 2020.

• This will entail heavy and extensive use of chemicals.

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 INTRODUCTION

• Employer has to assess whether there is significant

exposure of the chemicals to the worker and further
medical surveillance is necessary (OSH Classification,
Packaging and Labeling Regulation 1997).

• Further enhance the safe and healthy use of chemicals by

applying OSH Use of Standards of Exposure of
Chemicals Hazardous to Health Regulation 2000.
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 LEGAL PROVISION

• Occupational Safety and Health (Use Standard of

Exposure of Chemical Hazardous to Health)
Regulation 2000
• Health surveillance program (regulation 27)
• Medical removal protection (regulation 28)

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 LEGAL PROVISION

• Health surveillance program (regulation 27)

• Employer shall carry out health surveillance
program, conducted by Occupational Health Doctor,
OHD at intervals not more than 12 months.
• For employee who is exposed or likely to be exposed
to chemicals hazardous to health in schedule II.
• Medical record shall be kept for a period of thirty
years from the date of last entry made.
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 LEGAL PROVISION

• Medical removal protection (regulation 28)

• Employer shall not permit injured employee,
pregnant or breastfeeding employee to be
contacted with hazardous chemicals.
• Employee shall return to work after no longer
has detected medical condition and no longer
pregnant or breastfeeding a child.

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 WHAT IS MEDICAL
SURVEILLANCE?
• Ongoing systematic monitoring of health events and
exposures in working populations to prevent and control
occupational hazards, diseases and injuries.
• Cooperative effort among Management, Employees and
Health Professionals
• Based Upon:
• Job Activity
• Workplace Exposure Potential
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 PURPOSE OF MEDICAL
SURVEILLANCE
• Establish baselines
• Meet regulatory requirements
• Secondary prevention strategy (PROTECT
WORKER)
• Assess efficacy of existing controls
o identify problems and determine what changes may be
necessary

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CHEMICALS FOR WHICH MEDICAL
SURVEILLANCE IS APPROPRIATE

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 COMPONENT IN MEDICAL
SURVEILLANCE

• Pre-employment physical examinations

• Periodic health examinations
• Biological monitoring
• Investigation and notification of occupational disease
• Assist in disability assessment
• Return to work examination (after medical removal)
• Record keeping and monitoring 12
 PRE-EMPLOYMENT
EXAMINATION
• Provide basic information for monitoring fitness
over time and ability to perform work.

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PERIODIC EXAMINATION

• Purposes:
• Monitor possible changes in health status
• Determine levels of exposure to hazardous material
while completing job requirement

• The result will be compared to pre-employment

examination results

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 BASELINE / PERIODIC
MEDICAL EXAMINATION PARAMETERS

• Complete medical and work history, records of exposure

• Physical examination, BP, cardiovascular fitness
• Smoking habit, Lung function test / Spirometry
• Eye/Vision examination, ear examination & Audiogram.
• Urinalysis, Full Blood Count, ECG / EKG
• Blood chemistry (Diabetes, Lipid Profile, Renal Profile,
Liver Function Test)
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• Alcohol and Urinary Drug screening (eg. opiates &
cannabis)
• Heavy metal screen (as appropriate).
• Neurological System & Neurobehavioural Examination
• Evaluation of stresses related to repetitive motion,
heavy handling
• Screening for infectious diseases
• Evaluation of immune status and recommendation for
vaccination
• Psychological / mental state screening

• NOT ALL THE ABOVE NEED TO BE DONE, SELECT

ACCORDING TO OCCUPATIONAL NEEDS
 BIOLOGICAL MONITORING

• Test the presence of a hazardous substance in a

person’s biological materials (e.g. body tissue,
blood, urine, breath) in order to determine how
much chemical has entered the body following
exposure

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 BIOLOGICAL MONITORING

• For examples:
 lead is often measured in blood
mercury can be measured from a urine sample
cadmium exposure has been tested from hair
and fingernails
alcohol can be detected in exhaled breath
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 PURPOSE OF BIOLOGICAL
MONITORING
To assess health risk through evaluation of internal dose:
 amount of chemical recently absorbed – during
single work shift (determination of the pollutant’s
concentration in blood – take sample during the shift
or as late as the next day)

 case of chemical has long biological half-life –

internal dose reflect the amount absorbed over a
period of few months (metals in bloodstream)
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 amount of chemical stored – estimate
concentration of chemical in organs or tissues
(measurements of DDT in blood)

 indicate quantity of chemical at the site –

provide information about biological
effective dose (determine adducts formed by
toxic chemicals with protein in haemoglobin)
 INFORMATION REQUIRED FOR
SELECTING BIOLOGICAL TEST
• Knowledge of metabolism of substance in human
organism (toxicokinetics)
• Knowledge of alterations that occur in critical
organ (toxicodynamics)
• Existence of indicators
• Existence of sufficient accurate analytical method
• Existence of dose-effect and dose response
relationship 21
 ADVANTAGE OF
BIOLOGICAL MONITORING
• Attempt to measure the parameter most
directly related to potential health effects
• Exposures and individual variability are
assessed
• Exposures and routes of exposure can be
evaluated

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 LIMITATION OF
BIOLOGICAL MONITORING
• Effectiveness is dependent on adequate
toxicological data
• Test results can be affected by other factors such as
cigarette smoking, alcohol and pregnancy.
(Workers who smoke cigarettes, for example, may
have levels of cadmium higher than their
nonsmoking counter parts)

• Short biologic half-lives affect the monitoring 23

 INVESTIGATION AND NOTIFICATION OF
OCCUPATIONAL DISEASES/ACCIDENT

• Form investigation teams

• Each member should be train before appointed
• Internal notification – Notify employer
• External notification – Notify DOSH
• Conduct incident investigation – Gather evidence, analyze
causes, recommend corrective action
• Communicate, review and distribute report
• Follow-up (corrective and preventive action) 24
 DISABILITY
ASSESSMENT
• Limitation in performing work activities due to a
given health problem

• Steps in measuring work disability:

• Collection information (questionnaire, performance test,
medical assessment)
• Interpretation (guideline)
• Documentation (written report)
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EXAMPLES OF FUNCTIONAL
ABILITY LIST ITEMS

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 RETURN TO WORK

• Purposes:
• Help employer to minimize cost of injuries
resulting from actual medical compensation
disability cost
• Approach to management for early job
placement or retraining

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 RETURN TO WORK

• How?
• Employees who are injured are treated
with dignity and respect
• Employees will be given the best medical
care to speed recovery and return to work
• Identify alternative productive work duties
(job placement/reassigned)
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 RECORD KEEPING AND
MONITORING
• Vital part – keep track of employee’s health
• Medical record should includes:
• Social security number
• Written opinions from physician on health status
• Recommended limitations on work activities
• Results and information of treatment received
(for any medical condition)
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MEDICAL SURVEILLANCE PROGRAM FLOW CHART

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 WHO INVOLVE?

• Occupational Health Doctor – registered with

Malaysian Medical Council (MMC)
• Employer
• Employee

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 RESPONSIBILITIES

OCCUPATIONAL HEALTH DOCTOR, OHD

•Conduct medical surveillance
•Determine ability to work while using PPE
•Investigate and analyze Occupational Disease and
Poisoning, notify to DOSH and employer

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 RESPONSIBILITIES
EMPLOYER
•Provide and conducted medical surveillance
•Appoint OHD for company
•Provide training to the worker for safe handling
chemical activity
•Permitted whose in medical removal period from
exposed to the hazardous chemicals
•Provide workplace that are safe, improved hygiene and
healthy
•Record keeping medical surveillance records
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 RESPONSIBILITIES

EMPLOYEE
•Attend training provided by the company
•Report early symptom and sign of disease
•Co-operate with medical surveillance program

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 ASBESTOS
• PHYSICOCHEMICAL PROPERTIES
• 2 groups

• Route of entry : INHALATION

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Chrysotile – white asbestos Crocidolite – blue asbestos Amosite – brown asbestos

Anthophylite Tremolite Actinolite

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 OCCUPATIONS AT RISK OF
EXPOSURE

Asbestos milling and processing

• Manufacture and use of asbestos-cement
products (roofing sheets, wall boards, fireproof
cloth, brakes and clutch linings)
• Insulation work (removal or replacement of
asbestos insulation of furnaces)

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 TOXIC EFFECTS

• Confirmed human carcinogen (IARC 1)

• Signs of toxicity are usually delayed at least
15 – 30 years
• Diseases:
• Pleural plaques, mesothelioma, benign pleural
effusion, chronic bronchitis, brochogenic
cancer, cancer of laryx, gastro-intestinal cancers
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 MEDICAL SURVEILLANCE
PROGRAM
• PRE-PLACEMENT MEDICAL EXAMINATION
• Clinical examination and baseline data emphasis on
respiratory systems, pulmonary function test, chest x-ray
• PERIODIC MEDICAL EXAMINATION
• Annual clinical examination emphasis on lungs and repeated
chest x-ray
• Note: it is not yet established whether the disease can be
diagnosed at a stage when progression would cease if
further exposure to asbestos is avoided
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 MEDICAL SURVEILLANCE
PROGRAM
• WHERE INDICATED, THE FOLLOWING TEST
MAY BE DONE
• Sputum examination
• Carbon monoxide transfer factor
• INDICATIONS FOR MEDICAL REMOVAL
PROTECTION
• Early stage of asbestos diseases have occurred
• Worker is symptomatic
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 FOLLOW-UP ACTION

• ABNORMAL RESULTS
• Suspected asbestosis: repeat chest x-ray and clinical
examination after 1 year
• Definite asbestosis: repeat chest x-ray and clinical
examination more frequent to exclude complications
• MEDICALLY REMOVED WORKER AND
RETURN TO WORK
• Recommend worker for return to work when workplace
hygiene is safe and healthy, permitted from exposure to
asbestos
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 FOLLOW-UP ACTION
• TREATMENT
• There is no definitive treatment for asbestosis
• Suspected bronchogenic cancer or
mesothelioma should referred to specialist
• Symptomatic asbestosis cases required
treatment when indicated

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 PREVENTIVE MEASURES

• Young person under 18 years of age should not be

exposed to asbestos
• Workers should be advice to stop smoking (smoking
has synergistic effect on likelihood of lung cancer if
there is asbestos exposure)
• Crocidolite prohibited for all purpose (except for
research and analytical purpose)
• Appropriate signage
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 REFERENCES

1. Guidelines on Medical Surveillance, Department

of Occupational Safety and Health, 2001. ISBN
983-2104-16-6
2. Guideline on The Control of Chemicals
Hazardous to Health, Department of
Occupational Safety and Health, 2001. ISBN
983-2014-10-7

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 Video

• https://www.youtube.com/watch?v=uCthFhKZh44