Medical Surveillance in Museums

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Medical Surveillance in Museums Galleries

• Katherine Duvall, MD, MPH, MS
• Co Director, Health in the Arts Program
• University of Illinois at Chicago

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What is Medical Surveillance?

• Systematic collection and analysis of data to
  detect early signs of work-related illness
• Can be considered as a type of medical screening
• Is backup to industrial hygiene exposure
  assessment

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Why Do Medical Surveillance?

• The purpose is to identify work related disease
  at an early stage
• Early detection may result in more successful
  treatment
• Can identify risk factors for disease/injury
• May detect non-work related disease
• Health promotion

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When is a Medical Surveillance Program Needed?

• When exposures exceed the action level
• If new materials or processes are introduced and
  leading to concern of worker safety

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What is Involved in Medical Surveillance?

• History
• Physical exam
• Testing
• Analysis of results
• Communication of results
• Maintain records

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What are the Steps in Medical Surveillance?

• Needs assessment
• Selecting target population
• Selecting tests
• Interpretation of tests
• Intervention if needed
• communication

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Needs Assessment

• Potential for exposure
• Review toxicity of materials
• Guidelines OSHA, ACGIH, NIOSH
• Is medical surveillance needed
• Frequency of testing

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Target Population

• Who is potentially exposed?
• Based on current employees

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Test Selection

• Lab testblood, urine
• Chest x-rays
• Lung function testing
• Hearing tests

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Interpretation of Tests

• Must have protocol for results
• Refer to primary physician?
• Remove from exposure?
• False positives
• False negatives

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Intervention

• Does employee need to be removed from exposure?
• Does process/materials need to be changed?
• Environmental controls?
• Personal protection equipment?

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Communication

• Inform employee of results in writing
• Inform supervisor of restrictions if needed

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Biological Monitoring

• Test biological specimen (blood, urine, etc.) for
  presence of toxin
• Assess exposure to toxin
• Does not necessarily mean disease
• Half life important in terms of when to collect

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Biological Monitoring (continued)

• Can evaluate multiple exposures
• Measures what is most directly related to
  potential health effects

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Lead

• Can be present in paint and glazes, stained glass
• Can affect central nervous system, kidneys,
  peripheral nerves, blood, reproduction
• OSHA Lead Standard
• History, physical exam
• Blood lead and ZPP
• Level over 40ug/100ml means significant
  overexposure
• Remove worker if level is gt 60ug

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Mercury

• Used as pesticide, pigment or preservative
• Can cause central nervous system, behavioral and
  renal effects
• History, physical exam
• Urine testing

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Arsenic

• Can be used as pesticide
• Affects skin, liver, nervous system
• Is a risk factor for lung cancer
• History and physical exam
• Urine test (can be affected by seafood
  consumption)

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Solvents

• Used to clean and thin paints
• Can affect skin, liver, blood (benzene),
  peripheral and central nervous systems
• History and physical exam
• Urine for metabolites
• Carbon monoxide in exhaled air, or
  carboxyhemoglobin in blood for methylene chloride

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Asbestos

• Used in plaster, fire retardants, taxidermy
• Can can pulmonary fibrosis
• Can result in lung cancer
• OSHA Asbestos Standard
• Annual exam and termination exam
• History, physical
• Pulmonary function study
• Periodic chest x-ray

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Summary

• OSHA general duty clause workplace must not
  have recognized hazards likely to cause death or
  serious physical harm to employees
• Medical surveillance can help protect the
  employee by early recognition of injury/illness
• Through biological monitoring, can also assess
  potential exposures

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Summary (continued)

• Medical surveillance protocol should include
• Purpose of medical surveillance and any
  particular focus on an organ system
• Type of examination, history items
• Schedule of surveillance
• Types of tests to obtain
• Acceptable levels for test
• How employee to be notified
• Intervention and action to be taken
• Follow up studies
• Record keeping