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Medical Surveillance

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Policy No.: '''2011''' <br />
Effective Date: '''02/15/2011''' <br />
Revised Date:'''12/02/21'''<br />Reviewed Date: '''0212/1402/201121'''<br />
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<big>'''Medical Surveillance Policy'''</big>
== Policy ==
The purpose of the medical surveillance program is to evaluate the health of employees related to their potential occupational exposures to hazardous agents. This program will also assure compliance with various regulations which require medical monitoring when employees use certain materials, are exposed to certain biological , chemical, radiological or physical hazards or are members of certain regulated occupational groups. This policy does not include ergonomic-related illnesses and work-related injuries/illnesses (worker's compensation claims) covered under the University Workers Compensation Program. <br /><br />Those working with animals should refer to the [https://wwwinfo.unmc.edu/iacuc/policiesdocs/indexpolicy-for-occupational-health-and-safety.html pdf IACUC Policy for Occupational Health and Safety for Personnel with Animal ContactExposure]. 
== Responsibility ==
=== Employee ===
#Complete the pre-employment medical surveillance based upon the position description or as determined following a review of the employee job tasks against the medical surveillance criteria.
#Participate in an on-going ongoing medical surveillance program based upon the position description or as determined following a review of the employee job tasks against the medical surveillance criteria. #Following an exposure or other adverse event, notify your supervisor /manager and do follow the following:##If obvious intervention is needed, report to Employee Health during business hours or to reporting guidance on the Emergency Department if during holidays, evenings or weekends; or ##If intervention is not obvious, call 9-OUCH (9-6824) or page 402-888-OUCH to discuss exposure and determine if medical intervention is needed. ##Follow the recommendation for intervention.#Following any exposure or adverse event, the employee must complete a UNMC [httphttps://www.unmc.edu/hrehs/Formssafety/FstRprtIncidentincident-reporting.pdf Confidential Report of Occurrencehtml Incident Reporting] form for incidents or injuries related occupational exposures to hazardous agentswebpage. <br />=== Supervisor /Manager === #Update position descriptions as needed to accurately reflect the elements of the job including exposures, personal protective equipment, physical requirements, etc. ##Based on the requirements of some positions at UNMC, the offer of employment is contingent upon successful completion of post-offer, pre-employment health services/examinations conducted through Nebraska Medicine Employee Health (EH).##To determine if a position requires pre-employment health services/examinations, review the Compliance/Occupational Health Requirements section of the candidate’s position description in PeopleAdmin.##Information indicating whether a service/examination is required based on the responsibilities and working environment of the position can be found on the NU Values - Employee Health Services webpage.#Review the [https://www.osha.gov/sites/default/files/publications/osha3162.pdf Medical Screening and Surveillance Requirements in OSHA Standards: A Guide] to determine if the employee job tasks against the require any medical screening or surveillance criteria listed below.#Coordinate with Employee Health EH when medical screening and surveillance is indicated for an employee.#Encourage employees to self -identify to Employee Health EH any medical concerns involving occupational exposure risks. #Contact Environmental Health and Safety (EHS) for questions about this process or for additional guidance. === The Campus Environmental Health and Safety Office ===#Serve Serves as program administrator and works with EH to coordinate the campus medical surveillance program. #Act Acts as liaison with the Employee Health EH personnel and other employees. #Provide Provides exposure evaluations when deemed necessary.#Provide Provides feedback to supervisors /managers on medical surveillance inquiries.#Monitors the Occupational Reviews Injury and Illness Report for possible research related accidents Reports and illnessesprovides follow-up as needed.
=== Employee Health ===
#Provide Provides initial medical surveillance exam for screening and ongoing employee surveillance based upon the position description or as determined following a review of the employee job tasks against the medical surveillance criteriarisk assessment. #Refer to other medical providers as deemed appropriate and approved by the medical center.#Make Makes recommendations based on the exam results. #Maintain Maintains medical records and make makes them available to employeeemployees.#Provide Provides post-exposure follow -up and referral as needed.
== Procedures/Guidelines ==
=== Pre-Employment Medical Surveillance Criteria ===
Departments will review and update position descriptions prior to posting to assure they accurately reflect the elements of the job including exposures, personal protective equipment, and physical requirements, etc. Employees' inclusion in the medical surveillance program will be based on the elements of the job and safety surveys in which exposures to various stressors are evaluated.<br /><br />Campus Safety will request list of those personnel in positions with job elements meeting the medical surveillance criteria annually. <br /><br />Departments are responsible for scheduling periodic exams as required and, when necessary, medical surveillance examinations will be scheduled for affected employees with the Employee HealthEH. <br /><br />Generally, affected Affected employees will undergo a work history, a medical history, and a medical examination; these elements are used to establish a baseline of the employees' health and then used to monitor their future health as it relates to their potential occupational exposures to hazardous agentssubstances.<br /><br />Specific test results and other personal medical information generated by these exams will be kept confidential between the employee and medical personnel. The employee can contact the health care professional who performed the exam with any questions regarding the test results. According to federal law, employees have the right to request copies of their medical or exposure records at any time by contacting Employee Health EH for medical records and Campus Safety EHS for exposure records. Campus Safety EHS has adopted these criteria based on OSHA requirements. The criteria are subject to modification upon periodic review. <br /> More information on medical screening and surveillance can be found in the [httphttps://infowww.unmcosha.edugov/mediasites/safetydefault/Table1RequiredMedicalExaminationbyJob.pdf Table 1] lists examples of jobs which required a medical examination. It is not all inclusive. [http:files/publications/info.unmc.edu/media/safety/Table2MedicalExaminationsosha3162.pdf Table 2Medical Screening and Surveillance Requirements in OSHA Standards: A Guide] lists the medical examination parameters.<br /><br /> Medical screening and surveillance will be required implemented in accordance with OSHA standards for employees those who:#Have exposure to noise levels exceeding 85 dBA in an 8 -hour time weighted average exposure.
#Wear a respirator.
#Have exposure to asbestos above the permissible limit or excursion limit for 30 days/year; perform Class 1, 2, or 3 asbestos work for 30 days/year. #Use any of the following 13 OSHA regulated human carcinogens([https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1003 OSHA 49 CFR 1910-1003]):#* #4-Nitrobiphenyl, CAS 92933;#* Alpha#alpha-Naphthylamine, CAS No. 134327;#* Methyl Chloromethyl Ether#methyl chloromethyl ether, CAS No. 107302;#* #3,3' Dichlorobenzine Dichlorobenzidine (and its salt), CAS No. 91941;#* Bis#bis-Chloromethyl Etherether, CAS No. 542881;#* Beta#beta-Naphthylamine, CAS No. 91598;#* #Benzidine, CAS No. 92875;#* #4-Aminodiphenyl, CAS No. 92671;#* Ethyleneamine#Ethyleneimine, CAS No. 151564;#* Beta#beta-Propiolactone, CAS No. 57578;#* #2-Acetylamino FluorineAcetylaminofluorene, CAS No. 53963;#* #4- DimethylaminoazobenzineDimethylaminoazo-benzene, CAS No. 60117; or#* #N-Nitrosodimethylamine, CAS No. 62759.#Use Vinyl Chloride and are exposed above the action level([https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1017 OSHA CFR 49 1910.1017 (b)(1))]. #Use Inorganic arsenic Arsenic and are exposed above the action level for at least 30 days/year and based on previous exposure([https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1018 OSHA CFR 49 1910.1018 (b)]). #Use Metallic Lead, Inorganic Lead, or Organic Lead Soaps and are exposed above the action level for greater than 30 days/year. #Use Benzene and are exposed above the action level for greater than 30 days/year and based on additional requirements([https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1028 OSHA 29 CFR 1910.1028 (b)]). #Are exposed to or use biohazardous agents as a part of their job activities (to include "occupational exposure" to Bloodborne Pathogens [(see [httphttps://infowww.unmc.edu/ehs/safety/BBP_Exposure_Control_Plan.pdf UNMC Bloodborne Pathogen Exposure Control Plan])].#:NOTE: The [https://www.unmc.edu/ibc/ Institutional Biosafety Committee ] "Protocol for Research Involving Biohazardous Materials" must be completed and approved by the campus IBC prior to conducting research on campus with biohazardous agents or in any situation where select agents are used in research or diagnostic procedures. This protocol includes completion of a section entitled, "Risk for Occupational Exposure" which requires the primary investigator to describe precautions necessary to prevent occupational exposure to the biohazardous agent and to list the specific trainings training(s) and vaccination(s) required, if necessary, to handle the biohazardous agents. In additionsaddition, the PI or laboratory supervisor is required to obtain a copy of the Post Exposure Agent Specific Protocol for the biohazardous agent being used in the laboratory. #Use 1,2 - Dibromo-3-Chloropropane, working in a regulated area or may be exposed in an emergency situation([https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1044 OSHA 29 CFR 1910.1044]). #Are exposed to Acrylonitrile above the action level([https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1045 OSHA 29 CFR 1910.1045 (b)]). #Are exposed to Ethylene Oxide at or above the action for at least 30 days/year([https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1047 OSHA 29 CFR 1910.1047 (b)]). #Are exposed to Formaldehyde greater than the action level or greater than the short -term exposure limit([https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1048 OSHA 29 CFR 1910.1048 (b) and 1910.1048 (c)(1)]). #Are exposed to Methylenedianiline greater than or equal to the action level for 30 days/year([https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1050 OSHA 29 CFR 1910.1050 (b)]). #Are exposed to Cadmium greater than or equal to the action level for 30days30 days/year([https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1027 OSHA 29 CFR 1910.1027 (b)]).
#Are members of a hazardous waste and emergency response (HAZMAT) team.
More information on medical screening and surveillance can be found in the [https://www.osha.gov/sites/default/files/publications/osha3162.pdf Medical Screening and Surveillance Requirements in OSHA Standards: A Guide].
=== Exposures - Radioactive Materials ===
#For incidences not involving personal injury: ##, contact Radiation Safety Office: Dial 9during business hours at 402-559-6356. ##After Hours: Dial 9and after hours at 402-559-5555.
#For contamination involving personal injury (e.g., open wounds, cuts, etc.) the procedure is as follows:
##Provide first aid and medical stabilization to the extent possible.
##Contact the Radiation Health Center Emergency number (ext. 9at 402-559-5299) for immediate help.<br />This information is included in the [httphttps://info.unmc.edu/mediasafety/safety-office/policies-resources/UNMC_FLIPCHARTemergprepguide.pdf Emergency Preparedness Guide].
=== Exposures - Chemicals ===
Contact the Campus Emergency Number 9402-559-5555 (call 911 if off -campus 911) If if the exposure has resulted in the person being grossly contaminated, injured or incapable of rending aid to themselves or if providing assistance to the injured party would put the rescuer at risk. Contact the 9-OUCH (9-6824) or 402-888-OUCH for guidance for all other chemical exposures. The poison control center Poison Control Center can provide some guidance but will need to know the name of the chemical/substance. In the Omaha area, call 402-955-5555 or call toll-free 1-800-222-1222.<br /><br /> This information is included in the [httphttps://info.unmc.edu/mediasafety/safety-office/policies-resources/UNMC_FLIPCHARTemergprepguide.pdf Emergency Preparedness Guide].
=== Exposures - Biological Agents and Materials ===
Contact 9402-559-OUCH (9402-559-6824) or 402-888-OUCH (402-888-6824, a pager) for guidance. This number will be answered 24/7 by the Medical Call Center triage an EH nurse who will determine where the employee should report for follow -up care. Expert consultation will guide the triage process. Case management for all biologic exposures will be completed through Employee HealthEH.<br /><br /> A post -exposure treatment algorithm and agent -specific protocols have been developed for biological agents and materials (referred to as the Post Exposure Agent Specific Protocols). Protocols have been established to address agents for the types of exposures that could occur on campus. All Institutional Biosafety Committee IBC applications involving research with biological agents must include information for post -exposure management. Information regarding biological incidents and spills is included in the [httphttps://info.unmc.edu/mediasafety/safety-office/policies-resources/UNMC_FLIPCHARTemergprepguide.pdf Emergency Preparedness Guide].
== Incident Reporting ==
A UNMC employees, students, and volunteers are required to complete an Incident Report for all accidents/incidents involving injury. Unsafe conditions or "Near-Miss" incidents that did not result in injury, did not involve patients, or occur in clinical areas may be reported to UNMC EHS using the [httphttps://wwwapp1.unmc.edu/hrforms/Formsehs/FstRprtIncidentehs_incident_report.pdf Confidential Report of Occurrencecfm Near Miss/Potential Hazard Form] form should be completed by the employee anytime there is an occurrence that could have or did result in an injury or damage to property. This includes Research-Related Adverse Events (see See [httphttps://www.unmc.edu/ibc/docs/ibc24_adverse_events_09apr2010.doc Reporting of Research-Related Adverse Event SOP#UNMC-IBC 24]) <br /><br />A First Report of Incident Form will need to be completed and signed by the supervisor with input from the employeefor additional steps for reporting Research-Related Adverse Events.
== Confidentiality and Access to Medical Records ==
Each person included as a part of the Medical Surveillance Program will have a confidential medical record including documentation of immunizations and other medical services received through the program. These records will be maintained in Employee HealthEH. Only immunization<br /test dates and > The EH clinic is authorized to share information pertinent , when necessary and as it pertains to job exposuressafety, and/or job functionsduties, or with EHS professionals at UNMC. EHS personnel are also bound by confidentiality and privacy regulations and assist with risk will be provided to the employee's supervisorassessment and mitigation, training, program enrollment and compliance tracking.
== Additional Information ==
*Contact [mailto:unmcehs@unmc.edu UNMC Environmental Health and Safety] or 402-559-6356*[httphttps://www.unmc.edu/ehs/about/index.html UNMC Environmental Health and Safety]*[https://www.unmc.edu/ehs/safety/safety_policies_plans_guidelines.html UNMC Environmental Health and Safety Policies, Plans and Guidelines]*Radiation Safety, 402-559-6356 (during business hours) or 402-559-5555 (after normal business hours)*[https://info.unmc.edu/mediasafety/safety-office/UNMC_FLIPCHARTpolicies-resources/emergprepguide.pdf Emergency Preparedness Guide]*[httphttps://infowww.unmc.edu/ehs/safety/BBP_Exposure_Control_Plan.pdf UNMC Bloodborne Pathogen Exposure Control Plan]*[httphttps://wwwinfo.unmc.edu/iacuc/docs/policy-for-occupational-health-and-safety-for-personnel-with-animal-contact.pdf IACUC Policy for Occupational Health and Safety for Personnel with Animal ContactExposure].*Table 1. [httphttps://infowww.unmc.edu/mediaehs/safety/Table1RequiredMedicalExaminationbyJobincident-reporting.pdf Required Medical Examination by Jobhtml UNMC Incident Reporting] *Table 2. [httphttps://infowww.unmc.edu/mediaehs/safety/Table2MedicalExaminationsIncidentReportForm.pdf Medical Examinations - specific examination parametersUNMC Incident Report] *[httphttps://wwwapp1.unmc.edu/hrforms/Formsehs/FstRprtIncidentehs_incident_report.pdf Confidential Report of Occurrencecfm UNMC Near Miss/Potential Hazard Form]*First Report of Incident Form*[httphttps://www.unmc.edu/ibc/docs/ibc24_adverse_events_09apr2010.doc Reporting of Research-Related Adverse Event SOP#UNMC-IBC 24]*See the [httphttps://infowww.unmcosha.edugov/safetysites/default/ Safety] website*Contact the [mailtofiles/publications/osha3162.pdf Medical Screening and Surveillance Requirements in OSHA Standards:jhauser@unmc.edu Safety ManagerA Guide] (402-559-7315)
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