Reports of suspected WRA may then encourage exposure control interventions. The development of WRA should be considered to be an occupational sentinel health event; to serve as a warning signal that material substitution, control of exposure, protective equipment, or medical care may be required; or that other workers may also be exposed. In addition, several categories of occupational characteristics indicate the need to consider that a risk of WRA exists in the workplace (Tables 2-5). As examples, asthmatic workers in industrial settings with exposure to dusts, fumes, and sprays would be expected to have an increased risk ofWEA, and those in domestic or industrial cleaning jobs would be subject to an increased risk of WEA related to common allergens and cleaning products.
Workers in bakeries or companies using diisocyanates would be expected to have an increased risk of OA compared with clerical workers. In the United States, the National Institute for Occupational Safety and Health (NIOSH), which is not a regulatory agency, may conduct thorough worksite evaluations, which are known as Health Hazard Evaluations (HHEs), in selected situations if requested by a worker or employer. Such HHEs include an objective assessment of exposures and the workers as well as recommendations for the specific worksite.
In addition, HHEs often lead to information that may benefit other worksites with similar hazards. Clinicians should also advise patients with suspected sensitizer-induced OA about requesting the employer (eg, through a workplace health and safety committee or union) or the workers compensation insurer to take actions that may reduce impairment in other cases and prevent cases (eg, by screening programs and improved exposure control).
If the physician has the permission of the patient, the employer may be contacted/advised regarding appropriate actions. Panel Consensus 11. For workers who are potentially exposed to sensitizers or uncontrolled levels of irritants, the panel advises primary prevention through the control of exposures (eg, elimination, substitution, process modification, respirator use, and engineering control). Secondary Prevention While primary prevention may markedly reduce the incidence of some causes of sensitizer-induced OA, the ongoing high prevalence and incidence of the disease indicates the need for secondary prevention also.