Health Surveillance. Reference Documents

Transcription

1 Health Surveillance Trevor Smith Consultant Occupational Physician Reference Documents Control of Substances Hazardous to Health Regulations 2002 HSE Guidance Note MS25 Medical Aspects of Occupational Asthma BOHRF Guidelines for the Prevention, Identification and Management of Occupational Asthma

2 The Legal Requirement CoSHH (1) Where it is appropriate for the protection of the health of his employees who are, or are liable to be, exposed to a substance hazardous to health, the employer shall ensure that such employees are under suitable health surveillance. (2) Health surveillance shall be treated as being appropriate where - (a) the employee is exposed to one of the substances specified in Column 1 of Schedule 6 and is engaged in a process specified in Column 2 of that Schedule, and there is a reasonable likelihood that an identifiable disease or adverse health effect will result from that exposure; or (b) the exposure of the employee to a substance hazardous to health is such that - (i) an identifiable disease or adverse health effect may be related to the exposure, (ii) there is a reasonable likelihood that the disease or effect may occur under the particular conditions of his work, and (iii) there are valid techniques for detecting indications of the disease or effect, and the technique of investigation is of low risk to the employee. Disease or Health Effect Disease Asthma Rhinitis Symptoms Wheezing Coughing Shortness of breath Chest tightness Sneezing Nasal irritation Runny nose Causation: sensitisation or irritation

3 Likelihood of Disease or Effect SWORD Data: Estimated annual incidence of asthma due to flour dust exposure at 811 cases per million employed over period Techniques for Detecting Disease History (eg. questionnaire) Allergy tests (skin prick testing and RAST) Serial Peak Flow Recording Lung function testing (spirometry)

4 The Evidence Base BOHRF Guidelines Recommendation Employers and their health and safety personnel should provide regular health surveillance to workers where a risk of occupational asthma is identified. Surveillance should include a respiratory questionnaire enquiring about work-related upper and lower respiratory symptoms, with additional functional and immunological tests, where appropriate. What is the Evidence? The likelihood of improvement or resolution of symptoms or of preventing deterioration is greater in workers who have relatively normal lung function at the time of diagnosis. The likelihood of improvement or resolution of symptoms or of preventing deterioration is greater in workers who have shorter duration of symptoms prior to diagnosis. Health surveillance can detect occupational asthma at an earlier stage of disease and outcome is improved in workers who are included in a health surveillance programme. Implies removal of exposure for any affected employee

5 HSE Guidance MS25 Pre employment (or pre assignment) assessment history and baseline lung function (spirometry). Questionnaire for identifying relevant symptoms at 6 and 12 weeks after starting employment (exposure) and at yearly intervals thereafter. Strong consideration should be given to measurement of lung function at these times Practical Issues Frequency of surveillance for flour dust exposure Questionnaires availability, accuracy and scrutiny Immunological tests Inclusion of spirometry Case follow up

6 Keeping Records Where health surveillance is undertaken there is a legal requirement, under CoSHH, for a health record to be kept and maintained for at least 40 years from the date of the last entry. The record should contain the identifying details of the employee, the history of jobs involving work with asthmagens and the conclusions of the health surveillance procedures. The conclusions should be phrased in terms of fitness for work. Clinical details of a confidential nature should not be entered in the health record. Case Management Finding a clinician with relevant expertise Investigating control measures Monitoring level of risk over a period of time

7 Health Surveillance to Monitor Risk