Managing Health Effects of Beryllium Exposure (2008) / Chapter Skim
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7 Designing a Beryllium Exposure and Disease-Management Program for Workers in the Air Force
7 Designing a Beryllium Exposure and Disease-Management Program for Workers in the Air Force
Pages 127-139
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From page 127... ...
This chapter provides some general guidelines for designing a preventive program. EXISTING MEDICAL SCREENING OR SURVEILLANCE PRACTICES Published beryllium exposure-management programs are summarized in Table 7-1.
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From page 128... ...
TABLE 7-1 Summary of Published Beryllium Exposure-Management Programs 128 Workers Program Components Comments Reference Brush Wellman Respiratory protection Program implementation Deubner and workers Dermal protection reduced BeS to Kent 2007 Work-area and plant hygiene practices 1.1% in new Worker training workers Atomic-weapons Engineering controls Program generally keeps Johnson et workers in United Respiratory protection exposures below 2 µg/m3 al. 2001 Kingdom Work-area hygiene practices Only one case of CBD in Medical surveillance for CBD 400 workers Beryllium workers For workers: NIOSH 2008 Understand risks Avoid inhalation and skin contact Avoid dust-suspending activities Participate in medical surveillance For employers: Knowing beryllium content of all materials Substitution of less hazardous materials, if feasible Minimizing number of workers exposed Engineering controls Keeping airborne concentrations as low as possible Exposure monitoring Risk communication Confining beryllium contamination to work area Respiratory protection Dermal protection Medical surveillance
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From page 129... ...
DOE and DOE Baseline inventory to identify operations and locations of potential 10 CFR 850 contractor workers beryllium contamination with potential Hazard assessment beryllium Initial exposure monitoring exposure Limitation of access to areas containing beryllium Reduction and minimization of exposures through engineering and work practice controls Keeping exposures below PEL of 2.0 µg/m3 Provision of respirators when requested by workers Setting of action level at 0.2 µg/m3 (8-h TWA) Maintaining removable surface contamination below 3 µg/100 cm2 in designated beryllium-handling areas and below 0.2 µg/100 cm2 when released to the public or for nonberyllium use For all areas exceeding action level, provision of protective respiratory, clothing, and other equipment; periodic monitoring; regulation of access to that area; installation of hygiene facilities and institution of hygiene practices; posting of warning signs Medical surveillance of all beryllium-associated workers Training of workers who could potentially be exposed Counseling of workers who have diagnosis of BeS or CBD Offer of medical-removal protection to sick or sensitized workers Accurate records of all information gathered Monitoring of the effectiveness of the program and provision of performance feedback 129
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From page 130... ...
Thus, the proposed beryllium exposure- and disease-management program described below is a general outline of a program that should be tailored to the Air Force's needs as more information becomes available. Figure 7-1 shows a framework for minimizing personnel exposure and risks posed by exposure to aerosolized beryllium in the Air Force.
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From page 131... ...
2004 BeLPT DOE nuclear facility CS Qx, CXR, BeLPT Welch et al. 2004 Machining Every 2 y (new and Qx, BeLPT Newman et al.
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From page 132... ...
Identify Jobs and Tasks with Potential Exposure to Beryllium Particles Assess Beryllium Exposures Identify Workers with Potential Exposure to Implement Exposure Reduction Plan Beryllium Particles (see Figure 7-2) Enroll Workers in Medical Surveillance & Conduct Exposure Monitoring Management Program Centralized Surveillance Data Base Evaluate effectiveness of industrial hygiene and surveillance program FIGURE 7-1 Beryllium exposure- and disease-management program.
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From page 133... ...
For jobs or tasks identified as having detectable airborne beryllium, consideration should be given to determining the beryllium particle size distribution by using stationary or personal cascade impactors. Determining the particle size distribution may require pooling samples related to a given job or task to provide detectable quantities of beryllium.
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From page 134... ...
• Establish and maintain a skin-protection program to protect workers' skin from contamination with beryllium dusts and solutions by keeping work surfaces and work areas clean; providing work gloves, long-sleeved shirts, long pants, and shoes that remain at the workplace; and providing showering and changing facilities. Worker Education and Training Programs Worker education and training programs should be in place and should include education of all new and current workers with potential for beryllium exposure as to health risks of beryllium, appropriate exposure reduction, and use of skin and respiratory protective equipment.
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From page 135... ...
No CBD CBD Counsel about risk Counsel on medical and career implications Offer option to change job Advise removal from exposure No further beryllium Continued beryllium If worker elects to Remove from exposure, exposure, periodic exposure, periodic medical continue exposure, regular medical follow-up medical monitoring monitoring continue regular medical follow-up Centralized Surveillance Data Base (Figure 7-1) FIGURE 7-2 Medical monitoring approach.
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From page 136... ...
The database should include followup clinical data on all workers identified with BeS and CBD so that questions regarding natural history and risk factors for progression can be addressed. SPECIFICS OF THE MEDICAL SCREENING PROGRAM Initial Medical Screening The committee advises that after workers have undergone education and training, including education as to the potential risks and benefits associated
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From page 137... ...
BeLPT results from initial testing and any necessary retesting should be evaluated and recorded before a worker is allowed to begin work with potential exposure to beryllium. Outcome of Initial Medical Screening Initial findings of the questionnaire, chest radiography, and spirometry should be reviewed by an appropriately trained medical provider to determine appropriate job placement and medical followup.
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From page 138... ...
A worker with BeS who is asymptomatic and has normal pulmonary-function test results, carbon monoxide diffusing capacity, and HRCT may not want to undergo bronchoscopy, unless abnormalities are found in a regular followup. A worker with BeS or other medical screening results that suggest CBD should be offered removal from beryllium exposure (discussed further below)
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From page 139... ...
Workers with CBD who discontinue work with beryllium should receive medical removal protection. If workers understand the risk and elect to continue exposure, their exposure should be kept as low as feasible, and they should have regular medical followup and regular advice about the risk of disease progression.
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