OSHA's New Silica Standard Contains Key Medical Surveillance Requirements
OSHA issued a final silica standard to reduce lung cancer, silicosis, chronic obstructive pulmonary disease, and kidney disease among 2.3 million workers exposed to respirable crystalline silica. Silicosis is an irreversible, often disabling, and sometimes fatal lung disease that increases the risk of lung cancer and active tuberculosis infection.
The new rule lowers permissible exposure limits (PELs), mandates control measures, worker training, and a written control plan, and comprises two standards, one for Construction and one for General Industry and Maritime.
About 676,000 workplaces come under the scope of compliance. Exposures occur when cutting, sawing, drilling, and crushing concrete, brick, ceramic tiles, rock and stone products. Abrasive blasting and hydraulic fracturing can also cause exposures. Quartz, the most common form of silica, is a component of sand, stone, rock, concrete, brick, block, and mortar. Silica dust is hazardous when very small (respirable) particles are inhaled. Lesser known exposures can occur in dental labs and jewelry production.
One significant requirement of the new rule: employers must provide medical exams to monitor highly exposed workers and give them information about their lung health. Click here to view specifics on the standard.
OSHA asserts that strong scienfitic evidence links exposure to respirable crystalline silicia to an increased risk of developing lung cancer. The World Health Organization (WHO) and the National Institutes of Health (NIH) have designated crystalline silica as a known human carcinogen, and the American Cancer Society has adopted the WHO and NIH determinations.
According to the new standard, medical surveillance must be made available at no cost to every employee who will be occupationally exposed to respirable crystalline silica at or above the action level (a concentration of airborne respirable crystalline silica of 25 μg/m3, calculated as an eight-hour time-weighted average) for 30 or more days per year. Averaged over an eight-hour shift, OSHA has reduced the PEL for respirable crystalline silica to 50 micrograms per cubic meter of air.
All medical exams and procedures must be performed by physicians or other licensed health care professionals (OSHA uses the acronym PLHCPs). OSHA's PLHCP designation refers to "an individual whose legally permitted scope of practice (i.e. license, registration, or certification) allows him or her to independently provide some or all of the particular "health care services required" by the respirable crystalline silica standard. Professionals should have a thorough knowledge of respirable crystalline silica-related diseases and symptoms. This is where occupational health services with direct access to medical professionals help ensure compliance. Occupational health service providers offer medical professional expertise, ease of scheduling, results notification, recordkeeping, reminder systems, and access to networks of credentialed occupational health clinics.
Medical professionals must administer a baseline medical exam within 30 days of a worker's initial exposure, unless the employee has received a medical examination that meets the requirements of the standard within the last three years, according to OSHA's standard.
The exam consists of:
- A medical and work history that emphasizes past, present, and anticipated exposure to respirable crystalline silica, dust, and other agents affecting the respiratory system; any history of respiratory system dysfunction (signs and symptoms of respiratory disease such as shortness of breath, cough, wheezing, etc.); history of tuberculosis; and smoking status and history;
- A physical examination with special emphasis on the respiratory system;
- A chest X-ray with interpretation by a certified B-reader;
- A pulmonary function test administered by a spirometry technician with a current certificiate from a NIOSH-approved spirometry course;
- Testing for latent tuberculosis infection; and
- Any other tests deemed appropriate by the medical professional.
Medical exams must be made available to exposed workers at least every three years, or more frequently if recommended by the healthcare professional.
The medical professional must explain to the employee the results of the medical exam and provide each employee with a written medical report within 30 days of each exam performed.
The written report includes:
- A statement indicating the results of the medical examination, including any medical condition(s) that place the employee at increased risk of impaired health from exposure to respirable crystalline silica and any medical conditions that require further evaluation or treatment;
- Any recommended limitations on the employee's use of respirators;
- Any recommended limitations on the employee's exposure to respirable crystalline silica; and
- A statement that the employee should be examined by a specialist if the chest X-ray is abnormal, or if referral to a specialist is deemed appropriate by the medical professional.
Medical professionals also provide written medical opinions to employers. If the opinion indicates an employee should be examined by a specialist, employers must make available a medical examination by a specialist within 30 days after receiving the written opinion.
Employers must maintain an accurate record for each employee covered by medical surveillance under the new silica standard.
Compliance deadlines: Medical surveillance obligations begin on June 23, 2018, for employees who will be occupationally exposed to respirable crystalline silica above the PEL for 30 or more days per year. Obligations start June 23, 2020, for employees who will be occupationally exposed to respirable crystalline silica at or above the action level for 30 or more days per year.