NIOSHA Recommended Medical Surveillance For Some Healthcare Workers

National Institute for Occupational Safety and Health (NIOSH) is recommending addition protections for healthcare workers who prepare, administer, or transport hazardous drugs or dispose of hazardous drug waste  To minimize or prevent exposure to chemical hazards, NIOSH is recommending that employers establish a medical surveillance program as part of a comprehensive prevention program that utilizes engineering controls, good work practices, personal protective equipment (PPE), and training to protect workers.

Medical surveillance involves collecting and interpreting data to detect changes in the health status of working populations potentially exposed to hazardous substances.The elements of a medical surveillance program are used to establish an initial baseline of workers' health and then monitor future health as it relates to their potential exposure to hazardous agents. This information can be used to identify and correct prevention failures leading to disease. In particular, an effective surveillance program begins with a hazard identification program that is integrated with surveillance for disease or illness.

NIOSH has indicated that for workers exposed to hazardous drugs, the medical surveillance program should include:

• Reproductive and general health questionnaires completed at the time of hire and periodically thereafter.
• History of drug handling as an estimate of prior and current exposure, including dates of duty assignment related to hazardous drugs and similar types of information.
• A plan to provide initial baseline clinical evaluation, including appropriately targeted medical history, physical examination, and laboratory testing for workers identified as being potentially exposed to hazardous drugs that anticipates their potential toxicities.
• A follow-up plan as needed for workers who have shown health changes suggesting toxicity or who have experienced an acute exposure (substantial skin contact or inhalation exposure, cleaning a large spill [a broken IV bag, leaking IV line], etc.).

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