Post-occupational health surveillance

When we talk about post-departmental health monitoring we mean the one that is carried out on workers after the cessation of exposure to occupational risk factors that have a long period of latency, since in many cases the damage that causes the risk may subsequently appear after cessation of exposure.
The right of workers to health surveillance against occupational hazards does not end with the cessation of exposure to certain risks.

Certain risk workers have a long latency period, and can cause health damage after cessation of work (retirement, business change) or risk exposure.

Such workers must continue to be subjected to preventive medical control. This health surveillance is known as post-ocupation, since it no longer pre-exists work exposure to these certain agents but nevertheless continues the possibility of delayed onset damage.

To determine who should perform post-departmental health monitoring, we must distinguish two situations:

• If the worker is still active in the company where the exposure took place, it is up to the prevention service responsible for monitoring the health of the company's workers, to monitor. In other words, it remains the company responsible for monitoring the health of these risks in addition to the current ones to which it may be exposed.

• If the worker has terminated the employment relationship, whether by retirement or change of company, national health system to carry out such post-occupational health surveillance.

If the worker is active, the situation of temporary disability from Professional Illness is declared during observation, in accordance with the provisions of the General Social Security Act. If suspicion is confirmed (or diagnosed with a retired worker) professional sickness declaration procedures will be initiated.

The health authority, in coordination with labour, has the responsibility to devise post-occupational health surveillance programs, as indicated by the General Health Law (General Health Law).

The Health Authority of each Autonomous Community collects information from the monitoring of workers who have been exposed and have ceased the employment relationship with the company and establishes the link between medical inspections, disability assessment teams and any of the agencies involved in the initiation of professional disease declaration procedures.

Article 37 Higher-level functions, RD 39/1997 de 17 de enero, (RSP) implementing the Prevention Services Regulations, in subparagraph (b), and (e) provides:

b) In the field of health surveillance, health activity shall cover, under the conditions laid down in Article 22 of Law 31/1995 on the Prevention of Occupational Risks:

1.º An initial workers' health assessment after onboarding or after assignment of specific tasks with new health risks.

2.º An assessment of the health of workers who resume work after prolonged absence for health reasons, in order to discover their possible professional origins and recommend appropriate action to protect workers.

3.º Health monitoring at regular intervals.

e) In cases where the nature of the risks inherent in the work makes it necessary, the right of workers to regularly monitor their health status should be extended beyond the termination of the employment relationship through the National Health System.

In paragraph 5 of Article 22. Health surveillance of the Law 31/1995 November 8 (LPRL), states:

5. In cases where the nature of the risks inherent in the work makes it necessary, the right of workers to regularly monitor their health status should be extended beyond the termination of the employment relationship, as determined by regulation.

Two agents where post-occupational health surveillance is essential are Asbestos and Silica, carcinogenic and with a long period of latency.

Asbestos Post-Occupational Health Surveillance

The post-annual monitoring of people still active in the same company where they came into contact with asbestos will be carried out by the Prevention Service responsible for the monitoring of the health of the company, that is, it remains the responsibility of the company. In the case of non-active persons (retired, etc.) or workers discharged from other companies post-occupational monitoring will be carried out by the National Health System.

Any worker with a history of exposure to asbestos who ceases the activity at risk, whatever the cause, shall undergo a health examination consisting of:

• Previous work history: review and update.
• Medical history: review and update, especially the habit of tobacco use and respiratory symptoms.
• Specific clinical examination including: inspection, pulmonary auscultation and cardiac auscultation.
• Imaging diagnosis (Posteroanterior Chest X-ray, left side, oblique) depending on the age of the worker and the period elapsed since the start of exposure.
• For the diagnosis of unsused asbestosis, a high-performance computed tomography (TCAR) may be included in the fifth year after the start of exposure, which may be repeated in successive periodic health examinations according to the results of the first TCAR and at medical discretion, taking into account the recommendations of the Spanish Society of Pneumology and Chest Surgery (SEPAR).
• Respiratory functional study (spirometry).
• Anti-smoking health board.

The perocity and additional content of successive post-occupational health examinations shall be determined by the physician responsible for the health examination based on the findings of the previous health examination. (Specific health surveillance protocol to Asbestos.3º edition. 2013 Ministry of Health)

Post-occupional health surveillance to silica

Silicosis may appear or evolve after exposure has ceased, so it is recommended to continue medical checks by the company as long as the worker continues there and does not disassociate himself from it (for termination of the contractual relationship with the company or by retirement), or by the specialized pneumology services of the Health System when such disengagement has occurred.

The periodicity of this post-occupational health surveillance shall be the same as that established for workers still exposed, that is, work history, medical history with personal history and current history, physical examination with cardiopulmonary auscultation, imaging tests with chest x-ray with posteroanterior projection and left side, with reading according to the International Labour Organization (ILO 2011), spirometry with interpretation according to SEPAR criteria and if they are workers affected by ITC/2585/2007, electrocardial realization.

Where a worker disassociates himself from the undertaking, for termination of contractual relationship with the company or by retirement, he shall be provided with information on the reasons that make post-employment surveillance advisable.

Monitoring of lung cancer health, tuberculosis and COPD is also recommended, potential damage also from exposure to silica.