Health monitoring means monitoring a worker to identify changes in health status because of exposure to hazardous chemicals at work. The purpose of health monitoring is to identify if exposure to a workplace hazardous chemical is impacting worker health. If carried out routinely it can be described as a health monitoring program.
There are different types of health monitoring procedures (outlined below) used to assess exposure to hazardous chemicals and their impacts on worker health:
This involves asking the worker questions about:
- previous occupational history, medical history and lifestyle habits
- for example dietary, smoking and drinking habits and where they live or have lived, and
- the presence of symptoms related to exposure.
It may also involve simple questions about:
- how workers carry out their work
- what they understand about the nature of their work
- personal protective equipment that they may use or have access to, and
- their personal hygiene at work or where they eat in the workplace.
These questions provide information to assess current or previous exposure to hazardous chemicals.
Counselling includes providing advice to the worker regarding the health effects of the hazardous chemicals including symptoms and health conditions that may develop. It should include information about both the acute and chronic or bioaccumulative effects of exposure.
This involves educating the worker about specific activities or medical conditions that may impact on symptoms of exposure. For example, for a worker with diagnosed renal impairment, the additive effects of smoking or eating seafood during a testing period should be discussed.
Counselling may also include discussing issues surrounding family planning, reproductive effects or possible effects on pregnancy or breast fed children if exposure to certain chemicals occurs.
This involves the use of standard clinical and medical assessments, tests and techniques to assess the presence of early or long term health effects, often at set intervals.
It could include a clinical examination, and tests like spirometry (lung function) and radiography, for example chest X-ray.
Biological effect monitoring
This is the measurement and assessment of early biological effects before health impairment occurs in exposed workers. For example, haematological (blood) profiling, monitoring of liver or kidney markers or measurement of the reduction of cholinesterase activity levels.
Biological exposure monitoring
This involves measurement and evaluation of the levels of a hazardous chemical or its metabolites in:
- body fluids including urine or blood
- body tissues such as build-up of a hazardous chemical in lungs, or
- exhaled breath.
In many cases, more than one monitoring method is used. Choosing the most appropriate health monitoring methods will depend on:
- the regulatory requirements for the chemical under the WHS laws
- the type of chemical involved
- the way the worker is exposed
- the level of exposure, and
- if it is possible to use a proactive method, like biological exposure monitoring, rather than a reactive method, like a medical examination.
Examinations and sampling procedures used in a health monitoring program should be safe, easy to perform, acceptable to workers and, where possible, non-invasive. However, when planning a health monitoring program and when interpreting results it is important to understand the limitations of the test method and results.
It is also important to remember the level of a hazardous chemical or its metabolites in the body may not necessarily correlate with workplace exposure to the hazardous chemicals (e.g. lifestyle behaviours may confound results), symptoms or adverse effects to health.
Experience needed to carry out health monitoring
The model WHS Regulations provide that health monitoring must be carried out by or under the supervision of a registered medical practitioner with experience in health monitoring.
Before agreeing to supervise or carry out health monitoring program you should ensure you have the necessary skills, qualifications and experience for this work.
Registered medical practitioners should be able to carry out the key requirements of a health monitoring program including:
- planning a health monitoring program specific for exposures to the relevant hazardous chemical that requires health monitoring
- implementing, monitoring and managing a health monitoring program
- recognising and harnessing specialist assistance when required
- sourcing, interpreting and applying best practice, medical, toxicological and epidemiological literature and integrate this knowledge into health monitoring programs, and
- advising and supervising other registered medical practitioners carrying out health monitoring.
For more about the elements of a health monitoring program see the Key elements of a health monitoring program guidance.