Now Available On-Line: Complete Letter Report On Incorporating Occupational Information in Electronic Health Records

Incorporating Occupational Information in Electronic Health Records: Letter Report

The National Academies Press

The National Academies Press (NAP) was created by the National Academies to publish the reports issued by the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council, all operating under a charter granted by the Congress of the United States. The NAP publishes more than 200 books a year on a wide range of topics in science, engineering, and health, capturing the most authoritative views on important issues in science and health policy. The institutions represented by the NAP are unique in that they attract the nation’s leading experts in every field to serve on their award-wining panels and committees. The nation turns to the work of NAP for definitive information on everything from space science to animal nutrition.

http://www.nap.edu/catalog.php?record_id=13207

Author:

David H. Wegman, Catharyn T. Liverman, Andrea M. Schultz, and Larisa M. Strawbridge, Editors; Committee on Occupational Information and Electronic Health Records; Institute of Medicine

84 pages PAPERBACK $35

Each year in the United States, more than 4,000 occupational fatalities and more than 3 million occupational injuries occur along with more than 160,000 cases of occupational illnesses. Incorporating patients' occupational information into electronic health records (EHRs) could lead to more informed clinical diagnosis and treatment plans as well as more effective policies, interventions, and prevention strategies to improve the overall health of the working population. At the request of the National Institute for Occupational Safety and Health, the IOM appointed a committee to examine the rationale and feasibility of incorporating occupational information in patients' EHRs. The IOM concluded that three data elements - occupation, industry, and work-relatedness - were ready for immediate focus, and made recommendations on moving forward efforts to incorporate these elements into EHRs.

Front Matter (R1-R10) 

Incorporating Occupational Information in Electronic Health Records (1-58) 

Appendix A: Workshop Agenda (59-64) 

Appendix B: Workshop Participants (65-68) 

Appendix C: Committee Biographies (69-74)

Recommendations:
Initial Focus on Occupation, Industry, and Work-Relatedness Data Elements

Recommendation 1: Conduct Demonstration Projects to Assess the Collection and Incorporation of Information on Occupation, Industry, and Work-Relatedness in the EHR

NIOSH, in conjunction with other relevant organizations and initiatives, such as the Public Health Data Standards Consortium and Integrating the Healthcare Enterprise (IHE) International, should conduct demonstration projects involving EHR vendors and health care provider organizations (diverse in the services they provide, populations they serve, and geographic locations) to assess the collection and incorporation of occupation, industry, and work-relatedness data in the EHR at different points in the workflow (including at registration, with the medical assistant, and with the clinician). Further, to examine the bidirectional exchange of occupational data between administrative databases and clinical components in the EHR, NIOSH in conjunction with IHE should conduct an interoperability-testing event (e.g., Connectathon) to demonstrate this bidirectional exchange of occupational information to establish proof of concept and, as appropriate, examine challenges related to variable sources of data and reconciliation of conflicting data.

Recommendation 2: Define the Requirements and Develop Information Models for Storing and Communicating Occupational Information

NIOSH, in conjunction with appropriate domain and informatics experts, should develop new or enhance existing information models for storing occupational information, beginning with occupation, industry, and work-relatedness data and later focusing on employer and exposure data. The information models should consider the various use cases in which the information could be used and use the recommended coding standards. For example, NIOSH should consider how best to use social history templates to collect a work history and the problem list to document exposures and abnormal findings and diagnoses with optional work-associated attributes for possible, probable, or definite causes; exposures; and impact on work.

Recommendation 3: Adopt Standard Occupational Classification (SOC) and North American Industry Classification System (NAICS) Coding Standards for Use in the EHR

NIOSH, with assistance from other federal agencies, organizations, and stakeholders (e.g., Bureau of Labor Statistics, Census Bureau, Council of State and Territorial Epidemiologists [CSTE], National Library of Medicine, National Institute of Standards and Technology, National Uniform Billing Committee, Health Level 7 International [HL7]), should recommend to the Health Information Technology (IT) Standards Committee the adoption of SOC and NAICS to code occupation and industry. Furthermore, NIOSH should develop models for reporting health data from EHRs by occupation and industry at different levels of granularity that are meaningful for clinical and public health use.

Recommendation 4: Assess Feasibility of Autocoding Occupational Information Collected in Clinical Settings

NIOSH should place high priority on completing the feasibility assessment of autocoding the narrative information on occupation and, where available, industry that currently is collected and recorded in certain clinical settings, such as the Dartmouth-Hitchcock health care system, Kaiser Permanente, New York State Occupational Health Clinic Network, Cambridge Health Alliance, and hospitals participating in the National Electronic Injury Surveillance System.

Recommendation 5: Develop Meaningful Use Metrics and Performance Measures

Based on findings from the various demonstration projects and feasibility studies, NIOSH, with the assistance of relevant professional organizations and the Health IT Policy Committee, should develop meaningful use metrics and health care performance measures for including occupational information in the meaningful use criteria, beginning with the incorporation of occupation, industry, and work-relatedness data, and later expanding as deemed appropriate to include other data elements such as exposures and employer.

Recommendation 6: Convene a Workshop to Assess Ethical and Privacy Concerns and Challenges Associated with Including Occupational Information in the EHR

NIOSH should convene a workshop involving representatives of labor unions, insurance organizations, health care professional organizations, workers’ compensation-related organizations (e.g., International Association of Industrial Accident Boards and Commissions, National Council on Compensation Insurance), and EHR vendors to 
.. assess the implications for the patient and clinician of incorporating work-relatedness in the EHR, with respect to workers’ compensation; and
.. propose guidelines and policies for protecting the patient’s non-workrelated health information from inadvertent disclosure and to ensure compliance with the Health Insurance Portability and Accountability Act, workers’ compensation, and other privacy standards.

Enhance the Value and Use of Occupational Information in the EHR

Recommendation 7: Develop and Test Innovative Methods for the Collection of Occupational Information for Linking to the EHR

NIOSH should initiate efforts in collaboration with large health care provider organizations, health insurance organizations, EHR vendors, and other stakeholders to develop and test methods for collecting occupational data from innovative sources. Specifically, NIOSH should evaluate collection methods that involve

.. patient input through mechanisms such as web-based portals and personal health records, and
.. other means such as health-related smart cards, health insurance cards, and human resource systems.

Recommendation 8: Develop Clinical Decision-Support Logic, Education Materials and Return-to-Work Tools

NIOSH, relevant professional organizations, and EHR vendors should begin to develop, test, and iteratively refine and expand

.. clinical decision-support tools for common occupational conditions (e.g., work-related asthma);
.. tools and programs that could be easily accessed for education of patients and caregivers about occupational illnesses, injuries, and workplace safety;
.. training modules for administrative staff to collect occupational information in different care settings; and
.. tools to improve and standardize functional job assessment and return- to-work documentation in EHRs, including standards for the transmission of these forms.

Recommendation 9: Develop and Assess Methods for Collecting Standardized Exposure Data

NIOSH should continue to work with occupational and environmental health clinics and other relevant stakeholders to develop and assess methods for collecting standardized exposure data for work-related health conditions. NIOSH should explore the feasibility of 

.. listing possible or probable exposures in the problem list or elsewhere in the EHR;
.. linking occupational information in the EHR to online occupational, toxicological, and hazardous materials databases, such as the Occupational Information Network (O*NET), the Association of Occupational and Environmental Clinics, and Haz-Map, to enhance diagnosis and treatment of work-related illnesses and injuries; and
.. automatically generating codes for exposures based on narrative text entries.

Recommendation 10: Assess the Impact of Incorporating Occupational Information in the EHR on Meaningful Use Goals

NIOSH, in conjunction with relevant stakeholders (e.g., Public Health Data Standards Consortium, CSTE, Association of State and Territorial Health Officials), should

.. develop measures and conduct periodic studies to assess the impact of integrating occupational information in EHRs, and
.. estimate the economic impact of EHR-facilitated return-to-work practices for both work-related and non-work-related conditions.

The Health Reform Act Charts a New Course for Occupational Health Care

The occupational healthcare program embodied in the recently enacted legislation has the potential for being the most extensive, effective and innovated system ever enacted for delivering medical care to injured workers. The “Libby Care” provisions, and its envisioned prodigies, will embrace more exposed workers, diseases and geographical locations, than any other program of the past. Potential pilot programs  will now be available to injured workers and their families who have become victims of the failed workers’ compensation occupational disease medical care system.

The legislation initially establishes a program for the identification, monitoring and treatment of those who were exposed to asbestos in Libby Montana where W.R. Grace formerly operated an asbestos (vermiculite) mine producing, among other things, attic insulation. The plant belched thousands of pounds of asbestos fiber into the air of the geographical area daily. Libby Montana has been declared a Federal Superfund Site and the asbestos disease that remains as its legacy has been declared a National Public Health Emergency.

The newly enacted national health care law will have profound effect upon the treatment of occupational disease.  Placed deep within the text of the bill (H.R. 3590), on page 836 (Section 1881A Medical Coverage for Individuals Exposed to Environmental Health Hazards), is the new occupational medical care model, “Libby Care.”  The Manager’s Amendment, embracing the concept of universal occupational health care, inserted in the final moments of the debate, will make all the difference in world to the future of medical care and the handling of work-related illnesses.

What We Learned From History

Historically it is well known that occupational diseases are problematic issues confronting workers’ compensation.They are problematic for all stakeholders in the system. For employers, it is difficult to defend a claim that may occur over a lengthy working period, ie. 280 days per year. Defending occupational disease claims has always been an elusive and a costly goal for employers and insurance carriers. Employees also are confronted with obstacles in obtaining timely medical benefits. Occupational disease claims are universally contested matter and medical care is therefore delayed until the claim is successfully litigated and potentially appealed. This process results in delay and denial of medical care and sometimes death.

In the 1950’s the insurance industry put tag-along verbiage in the statute to modify the 1911 workers’ compensation act to encompass occupational disease claims. This was not a philanthropic gesture, but one rather intended to shield Industry from rapidly spreading silicosis liability in civil actions emerging in the 1950s.

Over time, the failure of the workers’ compensation system to provide adequate medical care to injured workers suffering from occupational illness has given rise to the emergence of several attempted collateral benefit systems by the Federal government. The Black Lung Act-The Federal Coal Mine and Safety Act of 1969 established the Federal Black Lung Trust Fund, which obtained its revenue from the assessment of a percentage tonnage fee imposed on the entire Industry. In October 2000, the Federal government established The Energy Employees Occupational Compensation Program Act that provided a Federal bailout of liability for the monopolistic beryllium industry. The hastily enacted Smallpox Emergency Personnel Protection Act of 2003 (SEPA) shielded pharmaceutical manufacturers from liability.  Following the horrific events of September 11, 2001, the Federal government quickly established The Victims Compensation Fund to compensate the victims and their families through an administrative system.

The largest transfer of economic wealth in the United States from Industry to the private sector, other than in the Attorney General’s thirty-eight State tobacco litigation, emanated from asbestos litigation which had its geneses in workers’ compensation.   The late Irving Selikoff, MD’s pioneering efforts in providing expert testimony, based upon his sentinel studies of asbestos workers in Paterson, NJ, created the trigger mechanism for a massive wave of claims for occupational health care. The program never did adequately nor efficiently or expeditiously provide medical care.

The workers’ compensation system did not provide an adequate remedy because of a constellation of reasons, and subsequently, the wave spread to civil litigation out of desperation for adequate benefits. Asbestos litigation has been named, "The Longest Running Tort” in American history. While the Fairness in Asbestos Resolution Act of 2003, failed to be release from committee, the insurance industry tried to stifle the litigation but the effort failed.  Asbestos litigation expanded into  bankruptcy claims that continue unabated and the epidemic of disease continues. The remaining cases in the Federal court system were transferred to Federal Multi District Litigation (MDL 875) and the majority are finally concluding after twenty years of Panel consolidation. Medical benefits were not a direct component of that system. Unfortunately, asbestos is still not banned in the United States and the legacy of disease continues at historic rates.

The Costs

In a study prepared in 2000 by Dr. Steven Markowitz for a book entitled “Cost of Occupational Injuries  and Illnesses”, it was revealed that the direct medical costs attributed to occupation illness by taxpayers, amount to $51.8 Billion dollars per year for the hospital physicians and pharmaceutical expenses. Overall workers’ compensation is covering 27% percent of the cost. This amounts to 3% of the National Gross National Product. The cost is passed on to: employers, insurance carriers, consumers, injured workers and the taxpayer. Medicare, a target of the cost shifting mechanism employer by Industry, continues its “pay and chase” policy in an effort to seek reimbursement under the Medicare Secondary Payer Act. All the stakeholders and the compensation systems have become increasingly bogged down as cost-shifting continues by Industry. The workers' compensation claims process has become stagnant. 

Reportable Data A Questionable Affair

The quantification of occupational illness data has been very problematic as it is based on sources of questionable reliability. The US Bureau of Labor Statistics (BLS) based its collection on employer driven safety reporting, ieNCCI), keeps its data and procedures under wraps.

Both the NY Times and Nebraska Appleseed have reported that there exists underreporting of occupational disease conditions in epic proportions. They report that the elements of fear and intimidation directed to injured workers compound the defense attitude of employers and the insurance industry resulting in a massive underreporting of occupationally related medical conditions.

Increased Hurtles for Compensability

There have been attempts over the years to integrate more claims statutorily into the workers’ compensation system to shield employers from civil action and resultant large liability verdicts. This resulted in a flood of occupational exposure claims into the workers’ compensation arena. An effort in the mid-1980’s, following the asbestos litigation explosion, was by Industry to contain costs and restrict the payment of occupational disease claims even further in the workers’ compensation.

The initial effort was to create higher threshold standards and requirements in the area of mental stress claims. That was quickly followed by efforts to limit orthopedic and neurological carpal tunnel claims.  Restrictive language interpreting what is peculiar to employment further limited all occupational disease claims.

Furthermore, scientific evidence proof requirements became increasingly difficult to surmount. Daubert type arguments emerged by the defense in the nations’ workers’ compensation forums where simplicity of a remedial and efficient benefit delivery program had existed in the past. Where a biological marker was not present, as was in asbestos exposure claims, the establishment of causal relationship was universally challenged.

Pre-existing and co-existing factors soon became other hurtles for injured workers and their families.  Medical histories of orthopedic difficulties such as back conditions soon complicated repetitive motion trauma litigation. Co-existing and pre-existing smoking habits, family genetics and obesity were yet another obstacle to recovery.

Societal Habits Changed

Life and the way we look at work have changed dramatically with the onset of technology. Off-premises work is becoming more and more common with the advent of Internet access and economic globalization. Defining the barriers between work and pleasure has grown to be exceedingly difficult.

People are working harder and longer. More chronic conditions are prevalent in older workers. Disease increases with age and results in more total disability claims.

Occupational Medical Costs

The compensability of occupational claims is much more difficult to sustain in court. In recent studies over 99.9% of occupational deaths and 93.8% of the medical costs of occupational disease were held to be non-compensable. Over 50% of the lifetime medical costs are incurred during the last year of one’s life.

The Legacy of The Libby Montana Gold Rush

In 1881 gold miners discovered vermiculite, a form of asbestos in Libby, Montana. In 1920 The Zonolite Company was established and began to commercially mine vermiculite. W.R. Grace bought the mining operations in 1963. In 1990 the mine was closed and production ended.

For decades W.R. Grace belched over 5,000 pounds of asbestos into the air in and around Libby on a daily basis. The residents who worked at the plant and their families and household contacts were exposed to asbestos fiber.  Mineworkers brought home the asbestos on their clothing. The unknowing inhabitants and their families  used the asbestos to fill their gardens, their driveways, the high school track, the little league field and in their attics for insulation.

The US Environmental Protection Agency (EPA) visited Libby in 1999 and investigated the incidence of disease and the contamination of the site. The EPA declared Libby a Superfund site in October 2002 and a physical clean-up began of the geographical area. The question of who would pay for the medical care of Libby remained an unknown.

A Manager’s Amendment

Senator Max Baucus (D-MT), Chair of the Senate Finance Committee, utilizing a mechanism known as “A Manager’s Amendment,” at the last moment, modified the Senate’s version of the Health Care Reform Bill. The Patient Protection and Affordable Care Act passed the Senate, ultimate cleared the House and was signed into law by President Obama on March 23, 2010. Section 10323, Medicare Coverage for Individuals Exposed to Environmental Health Hazards, 2009 Cong US HR 3590, 111^th Congress, 1^st Session (December 31, 2009).

Senator Bacus said,  “This provision is important because it will provide vital medical services to American who—through no fault of their own—have suffered horrible effects from their exposure to deadly poisons. It will provide vital medical services we owe these Americans under our commitment in the Superfund Act.”  The amendment initially provides for screening and medical care to residents of the Libby Montana asbestos contaminated site that was owned and operated by W.R. Grace. It essentially provides for universal health care.

“Libby Care” Is The New Occupational Medical Care Model Legislation

The Libby site qualified for the medical program because the hazardous asbestos contaminated site in Libby was deemed to be “a public health emergency” on June 17, 2009 as defined by the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). While there are 1700 designated Superfund sites, Libby is the first site in the history of the program that has been designated as “a public health emergency.” The program may be expanded in adopted to other communities at the discretion of the Secretary of of the Department of Health and Human Services (HHS). 

The plan authorizes a grant for initial medical screening purposes. The screening would determine if a medical condition is present that is attributable to the environmental exposure. It allows those individuals with a diagnosed medical condition due to the environmental exposure at the site to get Medicare services. The Secretary of the Department of HHS may establish additional pilot programs to provide additional medical care appropriate for the residents of contaminated communities so designated. The delivery of Medicare medical benefits will be directed to those “who have suffered horrible effects from their exposure to deadly poisons.”

The purpose of the legislation is  “…. to furnish such comprehensive, coordinated and cost-effective care to individuals…..” p2224 l3-1. It mandates the furnishing of “Flexible Benefits and Services,” for items, benefits or services NOT covered or authorized by the Act. It further authorizes the institution of “Innovative Reimbursement Methodologies,” for reimbursement subject to offsets for individuals “eligible to receive public or private plan benefits or legal agreement.” p2226 ll8-11. The Secretary of HHS will maintain “waiver authority.”

Charting A New Course

After a century of struggle, the United States now embarks upon a new course for occupational medical care. The law charts a new path for the delivery of  occupational disease medical benefits on a timely basis. It will permit researchers an avenue for the collection of epidemiological data so that the workplace can be made safer. All will benefit. The innovative legislation provides for a long awaited and much needed initiative to provide an efficient, responsive and coordinated treatment plan and preventive health program that hopefully will expand and will vastly improve occupational health care.

To read more about health care and workers' compensation click here.

Occupational Illnesses Continue to Unnecessarily Kill Workers

A recent Letter to the Editor in the New York Times focuses on the fact that US workers continue to suffer from fatal occupational diseases and illness that are avoidable. 

Commenting on the feature article exposing the need to great enforcement of safety measures by OSHA, Tom O'Connor, Executive Director, National Council for Occupational Safety and Health, stated: "While nearly 5,000 workers die on the job each year, an estimated 50,000 more develop an occupational illness. Yet despite this toll, the federal government sits on rules that could help prevent workers from developing occupational illnesses. A proposed rule that would prevent workers from being exposed to dangerous levels of silica dust on the job has remained mired at the Office of Management and Budget for more than two years."

Click here to read the entire letter: LETTER Rules on Worker Health, Tom O'Connor Should Your Job Kill You?

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EC Publishes Criteria to Diagnose Occupational Illness

The European Commission has published a listing of the criteria for diagnosis occupational disease. The 272 page report is available on-line. It reviews hundreds of established occupational medical conditions.

a) The clinical features must fit in with what is known about the health effects following  exposure to the specified agent. The symptoms and signs should fit, and this may be supported in some cases by suitable diagnostic tests.

b) There must be indication of sufficient occupational exposure. Evidence on exposure may be obtained through taking the occupational history, results of occupational hygiene measurements taken at the workplace, biological monitoring results, and/or records of incidents of over-exposure.

c) The time interval between exposure and effect must be consistent with what is known about the natural history and progress of the disease. Exposure must precede health effects. However, in some conditions such as occupational asthma, a past history of childhood asthma and/or asthmatic attacks occurring before occupational exposure, does notautomatically rule out the possibility of a workplace agent causing subsequent asthmatic attacks.

d) The differential diagnosis must be considered. There are non-occupational conditions that have similar clinical features as occupational diseases, and a physician will have to take this into account before diagnosing or excluding an occupational disease.


To read more about occupational exposures and workers' compensation.

Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon  Gelman or call 1-973-696-7900.

OSHA Needs To Be Strengthened

If workplaces were safer then there would be no reason to have a workers' compensation program at all. OSHA, The Occupational Safety and Head Health Administration (OSHA), does just that, but its enforcement powers are lacking.

OSHA was created legislatively by Congress in 1970. In the years following  The National

Commission on Workmen's Compensation Laws in 1972 reported that safety should be encouraged, and that, "....Economic incentives in the program should reduce the number of work-related· injuries

and diseases." 

Today, The New York Times reports that "Occupational illness and injuries ....cost the American economy $250 Billion per year due to medical expenses and lost productivity."

English: A picture of David Michaels, Assistant Secretary of Labor. (Photo credit: Wikipedia)

"OSHA devotes most of its budget and attention to responding to here-and-now dangers rather than preventing the silent, slow killers that, in the end, take far more lives. Over the past four decades, the agency has written new standards with exposure limits for 16 of the most deadly workplace hazards, including lead, asbestos and arsenic. But for the tens of thousands of other dangerous substances American workers handle each day, employers are largely left to decide what exposure level is safe.

***

“"I’m the first to admit this [OSHA] is broken,' said David Michaels, the OSHA director, referring to the agency’s record on dealing with workplace health threats. 'Meanwhile, tens of thousands of people end up on the gurney.'"

Click here to read the complete article,  As OSHA Emphasizes Safety, Long-Term Health Risks Fester

Construction Injuries and Fatalities Cost California’s Economy $2.9 Billion Between 2008 and 2010

California Would Save Money by Using Its Buying Power to Reward Companies With Strong Safety Records

Occupational injuries and fatalities in the construction industry cost California residents $2.9 billion between 2008 and 2010, a new Public Citizen report shows.

The report, “The Price of Inaction: A Comprehensive Look at the Costs of Injuries and Fatalities in California’s Construction Industry,” quantifies the estimated costs of deaths and injuries in the state’s construction industry by considering an array of factors.

From 2008 to 2010, 168 construction workers were killed in workplace accidents in California. Additionally, the state recorded 50,700 construction-industry injuries and illnesses that required days away from work or a job transfer.

Drawing on a comprehensive 2004 journal article that analyzed the cost of occupational injuries, and combining the paper’s findings with updated fatality and injury data, Public Citizen determined that such incidents cost the state’s economy $2.9 billion during the three-year period.

“The economic picture is quite staggering,” said Keith Wrightson, worker safety and health advocate for Public Citizen’s Congress Watch division. “We now know that construction accidents impose huge economic costs in addition to tremendous pain for individual victims.”

As a partial solution, the report proposes that California pass a law requiring companies to demonstrate adherence to safety standards in order to be eligible to bid for state contracts. Such a solution not only would ensure that public-sector projects are fulfilled by responsible contractors but also would provide incentives for companies to maintain clean records while working on private-sector sites.

The report notes that California already screens construction companies to ensure that they have met performance standards in the past and haven’t violated any laws. The state also incorporates some safety standards in its prequalification system. But the system should be expanded to require construction firms to put greater emphasis on demonstrating that they provide safety training to workers and site supervisors, and that they have not had serious safety violations.

“Implementing a stricter prequalification process for public construction projects would not address all of the industry’s safety problems,” Wrightson said. “However, such a step would help further protect workers while also yielding significant gains to the economy for minimal costs.”

The report can be viewed at http://www.citizen.org/price-of-inaction-california-construction-safety-report.

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Health Care Workers Suffer Exposures to Antineoplastic Drugs

A recent study reveals that health care workers may be suffering from occupational exposure to chemotherapy drugs while treating cancer patients.

"Antineoplastic drugs are pharmaceuticals commonly used to treat cancer, which are generally referred to as 'chemotherapy'. Several studies have shown that exposure to antineoplastic drugs can cause toxic effects on reproduction as well as carcinogenic effects. Presence of these drugs in the urine of hospital personnel has been widely studied and dermal exposure has been suggested to be the main route of exposure. 

The main focus has been on handling the concentrated drug during preparation and administration of antineoplastic drugs and several approaches have been proposed on how to control those. Handling patient excreta has been considered to be potentially harmful to nurses working with cancer patients, since antineoplastic drugs are known to be present in patient excreta (e.g. urine, saliva, sweat, faeces, vomit), but this has not been studied in great detail in occupational exposure studies. 

The identification of occupational exposure to antineoplastic drugs in sectors outside the hospital environment (i.e. veterinary medicine, home care, nursing homes and industrial laundries) showed that the number of workers potentially exposed to antineoplastic drugs is larger than previously estimated. "

Click here to read the series of articles in The Annals of Occupational Hygiene

Exposure to Antineoplastic Drugs in Two UK Hospital Pharmacy Units 
H. J. Mason, S. Blair, C. Sams, K. Jones, S. J. Garfitt, M. J. Cuschieri, and P. J. Baxter 

A Pooled Analysis to Study Trends in Exposure to Antineoplastic Drugs among Nurses 
Wouter Fransman, Susan Peelen, Simone Hilhorst, Nel Roeleveld, Dick Heederik, and Hans Kromhout 

Occupational Dermal Exposure to Cyclophosphamide in Dutch Hospitals: A Pilot Study 
Wouter Fransman, Roel Vermeulen, And Hans Kromhout 

Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers 
Hans Kromhout, Fred Hoek, Ruud Uitterhoeve, Roel Huijbers, Roderik F. Overmars, Rob Anzion, and Roel Vermeulen 

Occupational Exposure Limits for Therapeutic Substances 
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The 6 Things You Need To Do If You Are Exposed To Mercury

Elemental mercury is a silver, odorless liquid.

Today's post comes from guest author Catherine Stanton from Pasternack Tilker Ziegler Walsh Stanton & Romano.

Irving J. Selikoff Center for Occupational & Environmental Medicine at Mount Sinai School of Medicine has released a guide to treatment for elemental mercury ((the pure form of the metal, when it is not combined with other chemicals) exposure. There are other forms of mercury, such as compounds found in contaminated fish, known as organic mercury and those are not covered by the guide.
Workers who experience a one-time sudden exposure to any chemical substance at work, should:

1. Gather as much information as you can about the type and amount of exposure, including labels, Material Safety Data Sheets (MSDS), and the medical emergency phone number on the MSDS. 
2. If you are feeling ill, seek medical attention at an emergency department (ED) immediately. It is best if a medical toxicologist is consulted as part of your visit to the ED. They can be reached for advice about treatment by having the healthcare professional contact the Poison Control Center at 1-800-222-1222. 
3. You can call the PCC independently for recommendations as well.
4. Once the urgent situation has been taken care of, you may contact the nearest occupational health clinic in the country for recommendations and follow-up.
5. This fact sheet is not a substitute for medical care. The purpose is to direct the exposed worker to the proper medical provider. 
6. Report any exposure to your employer immediately. Complete an incident or exposure form. If none is available, write a memo informing them of the exposure incident (date, time, location, what you were doing in the area, and for how long). Keep copies and insist that documents are placed in your personnel files.

You can download a copy of the fact sheet by clicking here. It contains more information about the following topics:

Symposium: Celebrating Dr. Irving J. Selikoff

Friday, October 16, 2015, 8:00 AM - 12:30 PM
Location: Davis Auditorium, Hess Building, 1470 Madison Ave (between 101st and 102nd Sts)

Program Overview
: This symposium will examine the lasting impact of the legacy of Dr. Irving J. Selikoff (January 15, 1915-May 20, 1992) on occupational health and safety in the United States. Considered the father of occupational medicine, he is remembered for his seminal research on asbestos-related illnesses, his tireless advocacy for worker safety and health protections, and his contributions to the establishment of federal asbestos regulations. 




Photo Exhibit
  In conjunction with the symposium, there will be an exhibit by photographer Earl Dotter on display titled Badges: A Memorial Tribute to Asbestos Workers. Guggenheim Pavilion Atrium, 1468 Madison Avenue.



Who should attend?
 This symposium is open to the public and intended for faculty, residents, students, and members of the occupational health and safety community.



Mount Sinai Organizing Committee  
Madelynn Azar-Cavanagh, MD; Philip J. Landrigan, MD, MSc; Roberto Lucchini, MD; John D. Meyer, MD, MPH; Barbara J. Niss; Robert O. Wright, MD, MPH



Registration
 There is no fee to attend this event. Click here to register for this event or email carla.azar@mssm.edu. Please note that space is limited and early registration is encouraged. 

Special Needs
The Icahn School of Medicine at Mount Sinai is in full compliance with provisions of the Americans with Disabilities Act (ADA) and is accessible for individuals with special needs. If you would like to attend this conference and require any special needs or accommodations, please contact carla.azar@mssm.edu.




Agenda

 

8:00 AM 
Breakfast and Check-in



9:00 AM 
Welcome Remarks

Robert O. Wright, MD, Chair, Dept. of Preventive Medicine, Icahn School of Medicine at Mount Sinai

Philip J. Landrigan, MD, Dean for Global Health, Icahn School of Medicine at Mount Sinai

David Michaels, PhD, MPH, Assistant Secretary of Labor for Occupational Safety and Health and Director, Occupational Safety and Health Administration (OSHA)

John Howard, MD, MPH, LLM, Director, National Institute for Occupational Safety and Health

Program Moderator

Roberto Lucchini, MD, Director, Division of Occupational and Environmental Medicine, Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai



9:30 AM
 Irving J. Selikoff in History

Albert Miller, MD, Director of the Pulmonary Function Laboratory, Albert Einstein College of Medicine and Emeritus Clinical Professor of Medicine, Icahn School of Medicine at Mount Sinai 



9:50 AM
 Asbestos and Selikoff’s role in the Reconception of Responsibility for Chronic Disease in a pre-OSHA era

David K. Rosner, PhD, MPH, Ronald H. Lauterstein Professor of Sociomedical Sciences and Professor of History, Graduate School of Arts and Sciences, Columbia University Mailman School of Public Health



10:10 AM 
Break



10:25 AM
 Update of the Selikoff’s Insulators’ Asbestos Cohort

Steven Markowitz, MD, DrPH, Barry Commoner Center for Health and the Environment, Queens College and Graduate Center, City University of New York



10:45 AM
 Pneumoconiosis and Autoimmune Disease from an Historical Perspective

Paul D. Blanc, MD, MSPH, Professor of Medicine and Endowed Chair, Occupational and Environmental Medicine, University of California San Francisco



11:05 AM 
Perspectives on Dr. Selikoff’s Contributions to Public Health and Safety Laws

Neil T. Leifer, Esq., Neil T Leifer, LLC, Auburndale, MA




11:25 AM
 Trends Today: Global Spread of Asbestos to Developing World

Barry I. Castleman, ScD, Author of Asbestos: Medical and Legal Aspects



11:45 AM 
Q&A



12:05 PM 
Introduction of Photo Exhibit

 Linda Reinstein, President/CEO, Asbestos Disease Awareness Organization 



12:10 PM
 Closing Remarks

Madelynn Azar-Cavanagh, MD, Medical Director, Mount Sinai Selikoff Centers for Occupational Health



Symposium: Celebrating Dr. Irving J. Selikoff
Sponsored by the Selikoff Centers for Occupational Health, Division of Occupational and Environmental Medicine, Dept. of Preventive Medicine, Icahn School of Medicine at Mount Sinai

Click here to read more about the late Irving J Selloff MD