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Policy No.: 2011
Effective Date: 02/15/2011
Revised Date:
Reviewed Date: 02/14/2011

Medical Surveillance Policy

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 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.

Those working with animals should refer to the Summary of the UNMC Occupational Health & Safety Program for Personnel with Animal Contact.

Responsibility

Employee

1. 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.
2. Participate in an on-going medical surveillance program based upon the position description or as determined following a review of the employee job tasks against the medical surveillance criteria.
3. Following an exposure or other adverse event, notify your supervisor and do the following:
   1. If obvious intervention is needed, report to Employee Health during business hours or to the Emergency Department if during holidays, evenings or weekends; or
   2. 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.
   3. Follow the recommendation for intervention.
4. Following any exposure or adverse event, the employee must complete a Confidential Report of Occurrence form for incidents or injuries related occupational exposures to hazardous agents.
   

Supervisor

1. Update position descriptions as needed to accurately reflect the elements of the job including exposures, personal protective equipment, physical requirements, etc.
2. Review employee job tasks against the medical surveillance criteria listed below.
3. Coordinate with Employee Health when medical surveillance is indicated for an employee.
4. Encourage employees to self identify to Employee Health any medical concerns involving occupational exposure risks.

The Campus Safety Office

1. Serve as program administrator and coordinate the campus medical surveillance program.
2. Act as liaison with the Employee Health personnel and other employees.
3. Provide exposure evaluations when deemed necessary.
4. Provide feedback to supervisors on medical surveillance inquiries.
5. Monitors the Occupational Injury and Illness Report for possible research related accidents and illnesses.

Employee Health

1. Provide medical surveillance exam for employee based upon the position description or as determined following a review of the employee job tasks against the medical surveillance criteria.
2. Refer to other medical providers as deemed appropriate and approved by the medical center.
3. Make recommendations based on the exam results.
4. Maintain medical records and make them available to employee.
5. Provide 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, 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.

Campus Safety will request list of those personnel in positions with job elements meeting the medical surveillance criteria annually.

Departments are responsible for scheduling periodic exams as required and, when necessary, medical surveillance examinations will be scheduled for affected employees with the Employee Health.

Generally, 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 agents.

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 for medical records and Campus Safety for exposure records. Campus Safety has adopted these criteria based on OSHA requirements. The criteria are subject to modification upon periodic review. Table 1 lists examples of jobs which required a medical examination. It is not all inclusive. Table 2 lists the medical examination parameters.

1. Medical surveillance will be required for employees who:
   
   1. Have exposure to noise levels exceeding 85 dBA in an 8 hour time weighted average exposure.
   2. Wear a respirator.
   3. 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.
   4. Use any of the following 13 OSHA regulated human carcinogens:

• :#:4-Nitrobiphenyl
• :#:Alpha-Naphthylamine
• :#:Methyl Chloromethyl Ether
• :#:3,3' Dichlorobenzine (and its salt)
• :#:Bis-Chloromethyl Ether
• :#:Beta-Naphthylamine
• :#:Benzidine
• :#:4-Aminodiphenyl
• :#:Ethyleneamine
• :#:Beta-Propiolactone
• :#:2-Acetylamino Fluorine
• :#:4- Dimethylaminoazobenzine
• :#:N-Nitrosodimethylamine

1. 1. Use Vinyl Chloride and are exposed above the action level.
   2. Use Inorganic arsenic and are exposed above the action level for at least 30 days/year and based on previous exposure.
   3. Use Metallic Lead, Inorganic Lead, or Organic Lead Soaps and are exposed above the action level for greater than 30 days/year.
   4. Use Benzene and are exposed above the action level for greater than 30 days/year and based on additional requirements.
   5. Are exposed to or use biohazardous agents as a part of their job activities (to include "occupational exposure" to Bloodborne Pathogens [see UNMC Bloodborne Pathogen Exposure Control Plan].
      

   NOTE: The 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 and vaccination(s) required, if necessary, to handle the biohazardous agents. In additions, 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.

   1. Use 1,2 - Dibromo-3-Chloropropane, working in a regulated area or may be exposed in an emergency situation.
   2. Are exposed to Acrylonitrile above the action level.
   3. Are exposed to Ethylene Oxide at or above the action for at least 30 days/year.
   4. Are exposed to Formaldehyde greater than the action level or greater than the short term exposure limit.
   5. Are exposed to Methylenedianiline greater than or equal to the action level for 30 days/year.
   6. Are exposed to Cadmium greater than or equal to the action level for 30days/year.
   7. Are members of a hazardous waste and emergency response (HAZMAT) team.

Exposures - Radioactive Materials

1. For incidences not involving personal injury:
   1. Radiation Safety Office: Dial 9-6356.
   2. After Hours: Dial 9-5555.
2. For contamination involving personal injury (e.g., open wounds, cuts, etc.) the procedure is as follows:
   1. Provide first aid and medical stabilization to the extent possible.
   2. Contact the Radiation Health Center Emergency number (ext. 9-5299) for immediate help.
      

This information is included in the Emergency Preparedness Guide

Exposures - Chemicals

Contact the Campus Emergency Number 9-5555 (off campus 911) 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 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.

This information is included in the Emergency Preparedness Guide.

Exposures - Biological Agents and Materials

Contact 9-OUCH (9-6824) or 402-888-OUCH (pager) for guidance. This number will be answered 24/7 by the Medical Call Center triage 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 Health.

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 applications involving research with biological agents must include information for post exposure management. Information regarding biological incidents and spills is included in the Emergency Preparedness Guide.

Incident Reporting

A Confidential Report of Occurrence 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 Reporting of Research-Related Adverse Event SOP#UNMC-IBC 24)

A First Report of Incident Form will need to be completed and signed by the supervisor with input from the employee.

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 Health. Only immunization/test dates and information pertinent to job exposures, job functions, or risk will be provided to the employee's supervisor.

Additional Information

• Emergency Preparedness Guide
• UNMC Bloodborne Pathogen Exposure Control Plan
• Summary of the UNMC Occupational Health & Safety Program for Personnel with Animal Contact
• Table 1. Required Medical Examination by Job
• Table 2. Medical Examinations - specific examination parameters
• Confidential Report of Occurrence
• First Report of Incident Form
• Reporting of Research-Related Adverse Event SOP#UNMC-IBC 24
• See the Safety website
• Contact the Safety Manager (402-559-7315)

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