Clinical experiences: development of a medical surveillance protocol for hazardous waste workers.

Medical surveillance of hazardous waste workers is essential for the health of these workers, who have unique, complex exposures. In order for this preventive tool to be effective, the supervising and/or examining physician must be educated about the specific health risks of hazardous waste workers and also must perform a comprehensive examination. Results of testing should be evaluated both for remarkable abnormalities as well as longitudinal subtle changes in individuals, and also for trends in workers with similar exposures. Fitness for duty determinations should be then made with appropriate communication of abnormalities and follow-up recommendations to both employers and employees. To date, clinical and research findings from clinical centers performing surveillance examinations on hazardous waste workers have not revealed remarkable abnormalities related to their potential exposures. The possible causes for these results include: (1) the workers have been well protected; (2) the current diagnostic methodologies are not sensitive enough to detect pathophysiologic changes; and (3) disease may not yet be manifest due to latency or cumulative effects of long-term low-dose exposure. In addition, one must keep in mind that previous clinical and research data were collected from test results of workers who were mainly involved in feasibility, as opposed to remediation, activities. With the prospective change of more clean-up involvement of hazardous waste workers, their potential for exposure may increase. Therefore, periodic collaborative evaluation of existing surveillance programs' results (e.g., every 5 years) is advised. This would allow determination of the efficacy of the current diagnostic methods in detecting disease, as well as the possible inclusion of more sensitive and/or specific newer technologies for use on a more routine basis.(ABSTRACT TRUNCATED AT 250 WORDS)