Medical Management

What are medical monitoring, management, and surveillance?

Medical monitoring, or screening, is a process in which a physician or licensed health care professional periodically examines a worker's health by collecting health information from the worker and perhaps conducting a physical examination or appropriate medical tests. Monitoring often involves the review of an employee-completed health questionnaire to help determine the overall health condition of the employee. A number of simple breathing tests and an examination of those areas of the body most prone to dermatitis may also be included in the monitoring. Identified health problems will often be followed up with further diagnostic tests and perhaps with a referral to a medical specialist if appropriate.

Medical management is the process in which employers, in conjunction with the physician, use medical information to help reduce health risks in the workplace. The management decisions may address broad issues, such as selecting a less irritating MRF or hand cleaner, or the decisions may apply only to specific employees. Temporary job reassignment to treat a serious case of dermatitis is an example of a possible medical management decision that addresses a specific employee (tertiary prevention of disease)

Medical surveillance is the systematic review of employee medical monitoring information to detect unrecognized patterns of adverse health effects that are related to employment. For large worker populations, it may be possible to apply statistical techniques to these analyses. Medical surveillance of objective medical information might be considered the the ultimate quality control check to ensure a healthy workplace.

Why is it important to do medical monitoring?

Whatever the exposure in a shop, control of MRF exposures may not eliminate all possibility of illness or injury due to exposure to MRFs. Medical monitoring of workers exposed will help identify those experiencing early evidence of respiratory impairment or dermatitis and allow prevention of disease progression.

Who should receive medical monitoring and when should it be performed?

Initially, all employees who will work directly with MRFs in the shop should receive medical monitoring after hire or before assignment in the MRF environment.

Periodic monitoring should be performed biennially or more frequently at the discretion of the physician or plant management.

What does medical monitoring consist of?

Completion of a validated respiratory symptom questionnaire that addresses all of the potential respiratory conditions that have been associated with MRF exposure. The American Thoracic Society (ATS) questionnaire addresses many of the respiratory conditions that have been associated with MRF exposure. However, it may not be adequate for asthma or hypersensitivity pneumonitis symptoms. A NIOSH asthma questionnaire is available on their website. The Medical Research Council of Great Britain (MRC) also has a respiratory symptom questionnaire which has an extensive set of instructions for its successful administration. (A new comprehensive questionnaire may be needed to provide comprehensive and reliable information.)

A skin examination by a physician or occupational health nurse that focuses on the most likely regions for development of MRF associated dermatitis.

Additional medical testing, such as pulmonary function testing, conducted at the discretion of the physician.

What symptoms or conditions are considered most important in the medical monitoring of MRF workers?

Treatment by a physician for a respiratory illness

Onset of wheezing or shortness of breath, especially if it occurs at work and improves when away from work

Onset of cough that produces phlegm

Tightness in the chest

Chills, fever and unusual weight loss

Unusual fatigue

Skin irritation

Eyes burning or nasal congestion while at work

What if the questionnaire, the skin examination, or other medical tests reveal problems that might arise from working with MRF?

It depends on the test results. For a worker with six or more months in the current exposure environment who has abnormal respiratory symptoms (new onset of, or increase in, abnormal symptoms) or dermatitis symptoms, abnormal symptoms need to be resurveyed during a follow-up monitoring to be performed within six months of the first exam.

If respiratory symptoms or tests persist, the employee should be referred for a special examination to check for asthma or hypersensitivity pneumonitis (HP).

What about employee self-reporting of symptoms or medical problems?

Employees should be strongly encouraged to report any medical condition that they feel may be related to their work with MRFs to the appropriate plant personnel. The requirement to report medical symptoms should be part of the employee's training and should be reemphasized during periodic monitoring.

Who pays for these medical procedures?

The employer pays for all the medical examinations and tests associated with the above-described medical monitoring program.

How will medical management take place if the physician finds a medical condition?

Again, it depends on the situation. In all cases, the employee is advised of the test results and referred for medical treatment as appropriate. If new onset asthma or new asthma attacks are diagnosed in an exposed workers, if hypersensitivity pneumonitis is diagnosed, or if contact dermatitis due to exposure to MRFs is diagnosed, the employer will begin an investigation in the area where the individual has been working to determine if there is a correctable condition that might have caused or contributed to the condition.

In some situations it may be necessary to relocate a worker in order to manage his or her health condition. Employees identified with special medical conditions will need to be re-evaluated on a periodic basis. This time period will be determined by the treating physician.

How and when is medical surveillance conducted?

The collected medical information should be reviewed periodically to see if unusual patterns of symptoms or disease are present. This process is done informally as information is gathered, but it should be done formally on a biennial basis. Large worker populations can be analyzed using statistical techniques to determine such things as the incidence or prevalence of dermatitis, adverse respiratory symptoms, or other parameters.