Document 2NmrvM8wxMB06kpRneRzLLOV6

ic plant General Managers, General Superintendents, Plant Managers Administrative Physicians, Industrial Hygiene and Safety Representatives Hmtsd tat*rtf|saIzatiaR Csrrstptaitnet a** April 27, 1984 9mm Frederick M. Toca, Ph.D. Manager-Industrial Hygiene fctjKt Revised Corporation Asbestos Guidelines and Radiation Guidelines Revised eopies of the Corporation guidelines for assisting in the protecting of our employees from the hazards associated with asbestos and ionizing radiation exposures are attached. The asbestos guidelines were revised by Health Services Personnel and include the criteria of the recent OSHA Emergency Temporary Standard (ETS) for Asbestos. The criteria of the ZTS is included, although a Federal appeals court struck down this Standard, because we believe that a permanent Standard .proposing the same criteria will be promulgated shortly. The ionizing radiation guidelines were revised by the Corporation Radiation Coanlttee and Industrial Hygiene Services. Included with this guideline are selected portions of the NRC regulations concerning Specific and General License requirements. These excerpts are included to provide information regarding the difference between the two types of licenses and an overview of the requirements of each type. Holders of the Industrial Hygiene Policy and Guidelines Manual should Insert the revised copy of the asbestos guidelines into Section I, I.B.-12 of this Manual and the revised copy of the radiation guidelines into Section I, I.H.-3 of the Manual. Please discard the original guidelines. JBM/mdd Attachments cc: Holders of Industrial Hygiene Poliey and Guidelines Manuals USX000094S Appiujdix i GUIDELINES FOE MEDICAL SURVEILLANCE ASBESTOS EXPOSURE The following guidelines for medical surveillance shall be followed Is ell United States Steel Corporation operations whenever exposure to Asbestos occurs. 1. All employees exposed to asbestos shall be provided (or made avail. Able) a comprehensive medical examination prior to first employment Is as occupation exposed to airborne concentration of asbestos fibers. These medical examinations will be required for any 7- to t-hou; time weighted average concentration of 0.1 fibers7ce, or for a greater con centration. (The OSKA Asbestos Standard permits this examination to occur within SO calendar days of the first exposure.) Annually thereafter and within SO calendar days before or after termi nation of employment in an occupation exposed to airborne concentra tion of asbestos fibers requiring a medical examination as designated above, a physical examination shall be provided or made available to these employees. Whenever pleural thickening is found on any routine ehest x-ray on an individual who has had any airborne asbestos exposure, this individual shall be kept under yearly medical surveillance. The minimum components of the examination shall be: (a). A medieal history, including a respiratory questionnaire to elieit symptomatology of respiratory disease. (b). A 14" x 17" chest x-ray - posterior-anterior view. Whenever there is evidence of pleural response, right and left oblique views and expiratory posterior-anterior view should be taken to confirm or rule out pleural findings. * (e). Pulmonary Function testing to include foreed vital capacity (FVC) and forced expiratory volume at 1 second (FEVj). 2. A complete work history shall be taken on initial assignment to an occupation where exposure to elrbome concentration of asbestos fibers will occur. This ts particularly important if changes in the cheet x-ray begin to occur. The work history will include all work experieneea in United States Steel and other non-United States Steel work experience to determine extent of exposure to aebestos. In order to be complete, military exposures, L, ship and shipyard exposures; hobbits; exposures of family members (father, brothers, grandfathers, mother, sisters, cte.) who might have brought asbestos fibers home on their clothing; living (home) location (geographic) for proximity to asbestos mining or manufacturing plant; and play.areas ^SXOOOO$47  Guidelines For Medical Surveillance Asbestos Sxposore 3. x The language for OSHA-200 Log recording for (b) and (c) has been agreed upon in a meeting held October 1* 1980 of Personnel, Medical, Labor Relations, Safety It Environment*] Health, Law, and Workers* Compensation It Casualty repre sentatives. * (d). Unilateral pleural thickening or plaques with or without adequate history of asbestos exposure (with or without cal- ' cification) and with or without pulmonary decrements. The . most likely explanation for the pleural thiekeaiag in this (c) group is one of the following: infection (pleural effusion) or hemorrhage, callous from rib fracture, radiation fibrosis, scleroderma, chronic mineral oil aspiration, metastatie disease, lymphoma, myeloma or a combination of these. DO HOT RECORD OH OSHA-200 LOO. Normal anatomical shadows -- pectoral shadow area, extra pleural fat deposits, serracus and external oblique musele shadows can usually be ruled out by the above mentioned (i.(b techniques. (e). Pulmonary Function Decrement only Emphysema. It is important to establish whether this is result of occupational exposure or is due to non-oeeupational origin. Differen tiation between obstructive and restrictive disease must be msde. Do not record on OSRA-200 Log unless occupationally related. Define cause if so recorded. (f) Normal Chest - further follow-up testing failed to substan tiate suspicions in original ehest x-ray or pulmonary function tests. The role of smoking in any pulmonary function decre ment must be carefully evaluated. Diffusing capacity deter minations may be helpful in ruling out pulmonary fibrosis and probably should be done. In coke plants, the possibility of coadworkers pneumoconiosis with or without foeal em;bysema 'must always be ruled out. 6. Recommendations to ths physician in discussing findings with the 'alfeeted employees: (a). All employees must be told of any positive findings found during his/her anamination and the United States Steel physi cian evaluation (also consultant if used) of these findings. Recorded exposure levels should also be given to the employee. Because of proper handling of asbestos today, these-anvironmental levels should ordinarily be helpful in allaying any fears of continued exposure to hatardous levels. USX0000949 "Guidelines 7r Medieal Surveillance Aibtitoi Exposure 2. gn relation to discarded wtitti from aabeetos factories. The Xnvirbnmental Health cult (corporate headquarters or plants) will be helpful in evaluating the. extent of work exposures. S. Tbs chest x-ray should be read by at least two United States.Steel * physicians or physicians selected by the plant physicians. Any positive chest x-ray shall be read by a "B" reader for confirmation f the findings. It is permissible to contract with a "BM reader to read all x-rays in this program. (A "B" reader is certified fol lowing successful completion of qualifying examination of 12S chest x-rays by KX05H and the American College of Radiology.) 4. A clinical evaluation leading to a diagnosis and recommendations will (a). Correlate all medieal findings history* physical findings, chest x-ray interpretation, pulmonary femetion results, and any other medical Information -- with the environmental exposure data. (b). Referral to s pulmonary speeialiet to aseiet in this evaluation stay he done at the option of the plant medieal director or ether examining physician. (c). Referral of the chest x-ray to another "B" reader may occasionally be necessary for the proper interpretation of the x-ray. % 5. The clinical evaluation will usually result in a diagnosis of one of the following, in descending order of importance: (a). Asbestosis - pulmonary infiltrate classified by I.L.O. System and documentation of exposure with or without pulmonary function decrements, end with or without pleural thickening or plaques (with or without calcification). Record on OSBA-200 Log as "Asbestosis". (b). Pleural thickening with a history of asbestos exposure bilateral pleural thickening or plaques (with or without calcification) and with or without pulmonary function decrements. Without pulmonary function decrements, no need to refer unless requested by employee. Record on OSHA-200 log as "Pleural thickening with asbestos exposure*. (c) Pleural thickening with a history of asbestos exposure ~ unilateral pleural thickening or plaques (with or without calcification) and with or without pulmonary function decrements. Without pulmonary function decrement, no need -- to refer unless requested by employee. Record on OSHA-200 Log as "Pleural thickening with asbestos exposure". This diagnosis is one of elimination from S.(d). USX0000948 Guidelines for Medical Surveillance Asbestos exposure 5. Zf believed to be nonoccupstional, then referral to private physician, if appropriate - follow yearly. (f). Morsel - yearly follow-up. (g). Those persons who have demonstrated radiologic changes in chest film, and who have been exposed to asbestos, should be removed from further exposure either through engineering means, or personal protective equipment (respirators, air masks, disposable clothing, etc.), or by removal from work in the exposure area. 7. Environmental monitoring - will be carried out by the Environmental Health unit (corporate headquarters or plants) according to requirements of the OSHA Asbestos Standard. USX0000951 guidelines Tor Medical Surveillance Atbetto* Exposure 4. (b). Pulmonary infiltrate due to asbestos exposure with or without .pleural reaction. Shall be advised that this, response is due probably to exposures of many years past. Depending upon the pulmonary function finding, the riek of continued deereneat is probably direetly correlated to continued smoking specially if any continued exposure is properly handled.by respiratory protection and is of very minimal. If any. moni tored value. The corporate headquarters Environmental Health unit shall prescribe the approved manner, of handling any continuing exposure. To be followed every year unless . pulmonary function is decreased, then at shorter intervals if clinically indicated. Every effort should be msde to get the Individual to STOP SMOKZNO if he/she is a smoker. The risk of lung cancer in those with parsnehymal infiltrate *is up to sixteen (16) times the risk of a non-smoker with the same exposure and ninety (90) times that of a worker who is a nonsmoker and not exposed to asbejstos. (c) . Bilateral or unilateral pleural thickening or plaques due to asbestos exposure (with or without calcification). Should be advised that this response is the result of many years of low level of exposure. This also should apt progress if the ex posure has been eliminated or properly controlled by proper handling of asbestos and by respiratory protection if exposure continues. Depending upon the pulmonary function findings, the risk of continued decrement is directly correlated with continued smoking especially if any continued exposure is properly bandied by respiratory protection and is of very minimal, if any, monitored value. The corporate head quarters Environmental Health unit shall prescribe the approved manner of handling any continuing exposure. To be followed yearly unless there is a'decrement in pulmonary function.then at shorter intervals if clinically indicated. Every effort should be made to get the individual to STOP SMOKING if be/shc is a smoker. The risk of lung cancer in those with bilateral pleural thickening or plaques is two and one-half (2-1/2) times those without pleural reaction. (d) . Unilateral pleural thickening or plaques (with or without cal cification) not the result of exposure to asbeetoi. Continue to follow on a yearly basis. (e) . Emphysema if believed due to occupational exposure - follow yearly unless otherwise indicated or requested by employee. ,,s*`>o0,SO