Hazardous waste surveillance question(s)

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lstudt
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Joined: Mon Nov 25, 2019 10:12 pm

Hazardous waste surveillance question(s)

Post by lstudt » Tue Dec 10, 2019 5:15 pm

Recently, we have had inquiries regarding what type of surveillance employees should have for either hazardous waste(s) and/or periodic exposure to asbestos. For the most part, the exposures discussed are either firefighter type exposures with full SCBA, etc. or a DNR type situation where DNR employees are asked to explore and possibly clean up possibly contaminated areas (asbestos, lead, mercury, etc.). There is only one exposure that had measurements for mercury and the levels were not significantly elevated to meet surveillance criteria.

What I am looking for, if it exists, is any recommendations for medical surveillance for periodic exposure to usually unknown hazardous material. We certainly do not want to over test either. Any thoughts, suggestions, or sources anyone is aware of? I found some nice reviews on the Dept of Defense website from 2007, I believe.

Thank you in advance for your assistance.



Robert Swotinsky MD
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Re: Hazardous waste surveillance question(s)

Post by Robert Swotinsky MD » Thu Dec 12, 2019 5:37 am

Consider the following core components:

A history and physical exam.
Pulmonary function tests.
Complete blood count. Blood chemistry screen that includes liver-related enzyme tests.
Urinalysis (basic).
Resting EKG (baseline, periodic if at/above 40 yo)
Audiogram
(Routine chest x-rays are not recommended in this setting.)

The common next question is, For which exposures should we test when there is no known, specific exposure? If there is a rationale for testing exposures in this setting, it is limited to those that persist, e.g., lead, PCBs. If one tests for short half-life exposures in this setting (e.g., mercury), any positive findings are likely to represent nonoccupational exposures.

lstudt
Posts: 2
Joined: Mon Nov 25, 2019 10:12 pm

Re: Hazardous waste surveillance question(s)

Post by lstudt » Tue Dec 17, 2019 3:27 pm

Thank you Dr. Swotinsky. I agree, the next question about what to do and how often is the difficult one. In some of the cases, we know of certain substances that employees were exposed to but not in measured amounts. Employees are scared and employers are not sure what they should or should not recommend. Any thoughts on how to approach the next step?

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