Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-848 - Arsenic › Section 296-848-60020 - Medical guidelines

Current through Register Vol. 24-14, July 15, 2024
(1) You must make this section
			 readily available to employees as required in Training, WAC
			 296-848-30005.
(2) You must provide this section
			 to the licensed health care professional (LHCP) as required in Step 4
			 of the medical evaluation process found in Medical evaluations, WAC
			 296-848-30030.
Table 6
Medical Guidelines For Evaluating Employees
				With Exposure
Part 1: DOSH's
						Requirements
In addition to requiring employers
						to train employees and protect them from inorganic arsenic exposure,
						this chapter (the Arsenic rule) requires employers to monitor their
						employees' health with assistance from licensed health care
						professionals (LHCPs).
* For employees who will use
						respirators, the LHCP will also need to provide the employer with a
						written medical opinion clearing the employee for workplace
						respirator use.
These guidelines were designed to
						support an informed partnership between the LHCP and the employer
						when monitoring the health of employees exposed to inorganic arsenic.
The employer initiates this
						partnership by providing the LHCP with a copy of the chapter and
						other supporting information about the employee and job conditions.
						The LHCP can then become familiar with the medical monitoring
						requirements found in WAC
						296-848-30030
						and
						296-848-30080,
						which address:
* Frequency and content for routine
						(initial and periodic) medical examinations and consultations;
* Emergency and other unplanned
						medical follow-up;
* Medical opinions;
* Medical records retention and
						content.
Part 2: Inorganic Arsenic
						Toxicology
Health information about
						inorganic arsenic, WAC 296-848-50020
provides
basic
						information
about the health effects and symptoms associated
						with inorganic arsenic exposure.
In addition, consider the following
						information:
Acute Poisoning
Exfoliative dermatitis and
						peripheral neuritis may develop in patients who survive health
						effects due to acute poisoning (by ingestion).
Acute toxic symptoms of trivalent
						arsenical poisoning are caused by severe inflammation of the mucous
						membranes and greatly increased permeability of the blood
						capillaries.
Acute and Chronic
						Poisoning
In cases of acute and chronic
						poisoning, toxic effects to the myocardium (the middle layer of the
						heart) reported on EKG changes are now largely discounted and are
						attributed to electrolyte disturbances concomitant with arsenicalism.
Arsenic has a depressant effect
						upon bone marrow, with disturbances of both red blood cell production
						(erythropoiesis) and myclopoiesis.
Chronic Poisoning
Cases of chronic poisoning caused
						by ingestion are generally linked to patients taking prescribed
						medications. However, sputum from inhaled inorganic arsenic can be
						swallowed in addition to other ingested inorganic arsenic due to
						hand-to-mouth transfer.
Skin lesions are usually melanotic
						and keratotic and may occasionally take the form of an intradermal
						cancer of the squamous cell type, but without infiltrative
						properties.
Chronic hepatitis and cirrhosis
						have been described. Liver damage is still debated and as yet the
						question is unanswered.
Polyneuritis may be the prominent feature,
						  but more frequently there are numbness and parasthenias of "glove and
						  stocking" distribution. Horizontal white lines (striations) on the
						  fingernails and toenails are commonly seen and are considered a
						  diagnostic accompaniment of arsenical polyneuritis.
References:
* Other sources for toxicology
						information include:
-
						ToxFAQsTM and the Toxicological Profile
						for Arsenic. Both of these free documents are available from the
						Agency for Toxic Substances and Disease Registry (ATSDR) and can be
						obtained by:
* Visiting
http://www.atsdr.cdc.gov/toxprofiles
OR
* Calling 1-888-422-8737.
- A variety of technical resources
						on arsenic, available from the National Institutes for Occupational
						Safety and Health (NIOSH) by visiting
						http://www.cdc.niosh/topics/chemicals.html [File Link Not
						Available]
Part 3: Clinical Evaluation
						of Employees Exposed to Inorganic Arsenic
IMPORTANT:
* When an employee will use a
						respirator during work, the LHCP will need to determine whether the
						employee can safely wear a respirator and what limitations, if any,
						apply.
Guidance for Physical
						Examinations
In addition to its immediate
						diagnostic usefulness, a patient's initial examination will provide a
						baseline for comparing future test results.
This chapter establishes the
						minimum content for medical examinations. Additional tests such as
						lateral and oblique X-rays or pulmonary function test may be useful.
You should also include palpation
						of superficial lymph nodes and a complete blood count when employees
						are exposed to any of the following compounds:
- Copper aceto-arsenite;
- Potassium arsenite;
- Sodium arsenite;
- Other arsenicals associated with lymphatic
						  cancer.
Arsenic trioxide and other inorganic
						  arsenical dusts don't give rise to radiological evidence or
						  pneumoconiosis.
Statutory Authority:
				  RCW  49.17.010,
				  49.17.040,
				  49.17.050,
				  49.17.060. 07-03-153,
				  § 296-848-60020, filed 1/23/07, effective
				  6/1/07.