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  • ACOEM Provides Input to OSHA on Key Issues Facing Agency in 2010

    February 26, 2010

    David Michaels
    Assistant Secretary of Labor
    Occupational Safety and Health
    U.S. Department of Labor
    200 Constitution Avenue, NW
    Washington, DC 20210 

    Dear Mr. Michaels:

    The American College of Occupational and Environmental Medicine (ACOEM) welcomes the opportunity to respond to the Occupational Safety and Health Administration’s (OSHA’s) request for input on key issues facing the agency.

    OSHA’s Fall 2009 Regulatory Priorities
    OSHA’s proposed regulatory agenda demonstrates a renewed commitment to worker safety and health. ACOEM looks forward to the opportunity to participate in the rulemaking process and to provide the perspective of physicians in the field of occupational and environmental medicine.

    Following are some preliminary comments regarding several of the projects on the agenda. Please note that the following are not listed by order of priority and do not necessarily reflect official positions of the College. Several of the projects outlined in the regulatory agenda are currently under active review by various committees and sections of the College.

    • Airborne Infectious Diseases – The College agrees with the OSHA’s observation that most current infection control efforts are intended primarily for patient protection and not for worker protection. The risk to health care workers (HCWs) from airborne infectious diseases needs to be addressed with greater emphasis. For example, the resurgence of cases of active pulmonary tuberculosis (TB) and the emergence of drug-resistant strains of TB, has increased the risk for HCWs.
    • Occupational Injury and Illness Recording and Reporting Requirements (Musculoskeletal Disorders) – ACOEM will be submitting comments on the proposal to revise the Occupational Injury and Illness Recording and Reporting regulation by restoring a column on the OSHA Form 300 to better identify work-related musculoskeletal disorders.
    • Crystalline Silica – Crystalline silica poses an occupational respiratory hazard. ACOEM has issued guidelines for Medical Surveillance of Workers Exposed to Crystalline Silica. 
    • Diacetyl – ACOEM has supported the need for regulatory action in connection with occupational exposures to diacetyl as well as other food flavorings. Occupational exposure to diacetyl is a major concern for several reasons. Of paramount importance is the insidious nature of the serious lung disease caused by diacetyl and other related substances. ACOEM supports your goal of regulating diacetyl along with related substances. Given the inevitable absence of data on many related standards, we suggest that consideration be given to a standard that addresses process health and safety management.
    • Slip, Trip, and Fall Hazards – There is an increasing amount of research that demonstrates that implementation of a broad-scale prevention program can significantly reduce slip, trip, and fall injury claims. 

    OSHA Injury and Illness Recording and Reporting
    A review of the utility of OSHA’s Injury and Illness Recording and Reporting is in order. Limitations of the OSHA Log in serving basic public health functions have long been recognized. By prescription of the OSH Act itself, the recordkeeping standard has always excluded first-aid cases, which as a result, does not reflect potentially serious near misses. From the public health perspective, the OSHA Log was created as a tool to describe the burden of occupational injuries and illnesses on society. This data drives occupational health and safety resources. It is also used to target interventions to address industries and processes that carry the greatest risk. When followed over time, the Log can help evaluate the effectiveness of these interventions. However, the Log can only support these functions to the extent that it is valid and reliably maintained. Most importantly, society’s interest in preventing work-related injuries and illnesses is foiled when the picture of the true burden of work-related injuries and illnesses is distorted. ACOEM is anxious to participate in a rigorous review of OSHA’s recordkeeping process. For example, we support the intent to transition to electronic reporting. We also encourage OSHA to identify a broader suite of metrics, beyond the Survey of Occupational Injuries and Illnesses, to portray the status of the health of working populations. We further support the use of multiple data sources, similar to those used by the Census for Fatal Occupational Injuries, to validate the OSHA log. ACOEM has a number of other specific recommendations which we are eager to review with OSHA staff.

    Lead Exposure
    ACOEM urges that all employers utilizing lead in the workplace, as well as physicians caring for the health of U.S. workers, adopt the Recommendations for Medical Management of Adult Lead Exposure[i] published by an expert panel in 2007. These provisions call for medical removal when a worker’s blood lead level (BLL) exceeds 20 mcg/dL on any two consecutive blood tests or any single value exceeds 30 mcg/dL. While the current OSHA standard applies only to workers exposed at the OSHA action level of airborne lead dust ≥30μg/m3 as an 8‐hour time‐weighted average, ACOEM believes that this standard should be applied to all lead exposed workers who have the potential to be exposed by lead ingestion, even in the absence of documented elevations in air lead levels. In addition, ACOEM urges OSHA to update its lead standard in order to better protect American workers and to align itself with the overwhelming scientific evidence of adverse health effects in adults with BLLs well below the OSHA limits.[ii] In keeping with the scientific evidence, ACOEM recommends that OSHA lower the medical removal BLL as outlined above.

    Written Safety and Health Programs Standard
    ACOEM encourages OSHA to initiate rulemaking to consider the benefits of requiring employers to have a written safety and health program. Additional actions by employers, including hazard surveillance and safety planning, can further enhance the health and safety of workers. For example, since 1991 the state of California has had a standard for written Injury and Illness Prevention Programs (California Title 8 CCR Section 3203). The College also urges that medical surveillance be an integral part of a health and safety programs standard. Furthermore, the standard should consider permitting the use of the threshold limit value (TLV) where there is a not a current permissible exposure limit (PEL).

    Medical Surveillance and Underserved Population
    For many occupational exposures, underserved populations are most at risk and traditional medical surveillance programs are not adequate. OSHA should identify opportunities for non-traditional medical surveillance for those in underserved populations. ACOEM’s Section on Underserved Occupational Populations can be a valuable resource to OSHA to meet the needs of this community.

    We look forward to working with OSHA and other stakeholders to identify and address workplace hazards to protect the health of workers.

    Hymel, Pam.gif 
    Pamela A. Hymel, MD

    cc: OSHA Docket Office
          Docet No. OSHA-2010-0004

    [i]Kosnett MJ, Wedeen RP, Rothenberg SJ, et al. Recommendations for medical management of adult lead exposure. Environ Health Perspect. 2007;115(3):463‐71.

    [ii]California Department of Public Health, Occupational Lead Poisoning Prevention Program (OLPPP). Medical Guidelines for the Lead Exposed Worker. May 2009. www.cdph.ca.gov/programs/olppp/Documents/medgdln.pdf.