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Federal `Register / Viol. 51, No. H9 '/ iFriday, ijune :20, 1988 ,/ Rules and Regulations 22789 IV. Disposal Procedures andOeanup A. Wastes-that are generated'byprocesses where asbestos, itremolite. anthofJhylltte.iand actinolHeiisiprescntinclude: l.iEmpty asbe8t08,;tremol|te. anthophyilite, and actinolite shippingoontainere. 2. Process waslesauchaa.cuttings, trimming8..or reject anateriala. 3. Housekeeping waste'from sweeping or vacuuming. 4. Asbestos fireproofing or insulating material that is ^removed from buildings. 5. Asbestos-containing building.products removed during building renovation or demolition. 6. Contaminated disposable protective clothing. B. Empty shipping bags can be flattened under exhaust hoods.and packed into airtight containers for disposal. Empty shipping drums arc difficult to clean and should be sealed. C. Vacuum logs or disposable paper filters should not be cleaned, but should be sprayed with a fine water mist and placed into a labeled waste container." D. Process waste and housekeeping waste should be wetted with water or a mixture of water and surfactant prior to packaging in disposable containers. E. Asbestos-containing material that is removed from buildings must be disposed of in leak-tight 6-mil thick plastic bags, plasticlined cardboard containers, or plastic-lined metal containers. These wastes, which are removed while wet. should be sealed in containers before they dry out to minimize ' the release of asbestos, tremolite. anthophyilite, and actinolite fibers during handling. V. Access to Information A Each year, your employer is required to inform you of the information contained in this standard and appendices for asbestos. In addition, your employer must instruct you in the proper work practices for handling asbestos-containing materials, and the correct use of protective equipment. B. Your employer is required to determine whether you are being exposed to asbestos. You or your representative has the right to * observe employee measurements and to record (he results obtained. Your employer is . required to inform you of.your exposure, and., if you are exposed above the permissible*. _ limit, he or she is required to inform you of the actions that arc being taken to reduce . your exposure to within the perniissible limit. C. Your employer is required to keep records of your exposures and medical examinations. These exposure records must be kept for at least thirty (30) years. Medical records must be kept for the period of your employment plu9 thirty (30) years. D. Your employer is required to release your exposure and medical records to your physician or designated representative upon your written request. Appendix I to 1926.38--Medical Surveillance Guidelines for Asbestos, Tremolite, Anthophyilite, and Actinolite, Non-Mandatory I. Route of Entry Inhalation ingestion. II. Toxicology Clinical-evidence of the adverse effects associated with exposure to asbestos, tremolite,. anthophyilite, and uctinolite. is present in theformof several'well-conducted epidemiological'Studiesdl occupationally exposed workers, family-contact&'df workers, and persons Itving near asbestos, tremolite. anthop'hylHte. and actinolite mines. These sludies have shown a definite association between exposure to asbestos, tremolite, anthophyllhe, and actindlite and an increased'incidence of1lung cancer.pleural and peritoneal mesothelioma, gastrointestinal cancer, and a9bestosis. The latter is a disabling fibrotic lung disease that is caused . only by exposure to asbestos. Exposure to asbestos, tremolite. anthophyilite, and actinolite has also been associated with an increased incidence of esophageal, kidney, laryngeal, pharyngeal and buccal cavity cancers. As with other known chronic occupational diseases, disease associated with asbestos, tremolite. anthophyilite, and actinolite generally appears about 20 years following the first occurrence of exposure: There are no known acute effects associated with exposure to asbestos, tremolite. anthophyilite. and actinolite. Epidemiological studies indicate that the risk of lung cancer among exposed workers who smoke cigarettes is greatly increased over the risk of lung cancer among nonexposed smokers or exposed nonsmokcr9. These studies suggest that cessation of smoking will reduce the risk of lung cancer for a person exposed to asbestos, tremolite. anthophyilite, and actinolite but will not reduce it to the same level of risk a9 that existing for an exposed worker who has never smoked. III. Signs and Symptoms of Exposure-Related Disease The signs and symptoms of lung cancer or gastrointestinal cancer induced by exposure to asbestos, tremolite. anthophyilite, and actinolite are not unique, except that a chest X-ray of an exposed patient with lung cancer may show pleural plaques, pleural calcification, or pleural fibrosis. Symptoms characteristic of mesothelioma include shortness of breath, pain in the walls of the ' chest, or abdominal pain. Mesothelioma has a much longer latency period compared with lung cancer (40 years versus 1$t>20 years).. arid mesothelioma is therefore more likely to be found among workers who were first exposed to asbestos at an early age. Mesothelioma is always fatal Asbestosis is pulmonary tibrosis caused by the accumulation of asbestos fibers in the lungs. Symptoms include shortness of breath, coughing, fatigue, and vague feelings of sickness. When the fibrosis worsens, shortness of breath occurs even at rest. The . diagnosis of asbestosis is based on a history of exposure to asbestos, the presence of characteristics radiologic changes, endinspiratory crackles (rales), and other clinical features of fibrosing lung disease. Pleural. plaques and thickening are observed on Xrays taken during the early stages of the disease. Asbestosis is often a progressive disease even in the absence ofcontinued exposure, although this appears to be a highly individualized'characteristic. In severe cases. death:may be-caused <byirespiratory or ' cardiac failure. IV. Surveillance and Preventive Considerations As noted above, expoaure to asbestos, tremolite, anthophyilite, and .actinolite has been linked to an increased risk of.lung cancer, mesothelioma, gastrointestinal cancer,.and.asbestosis amoqg occupationally exposed workers. Adequate screening tests to determine an'employee'Sfpotential for developing serious chronic di9ease9..such as a cancer, from exposure to asbestos, tremolite. anthophyilite. and actinolite do not presently exist. However, some tests, particularly chest X-rays and pulmonary function tests, may indicate that an employee has been overexposed to asbestos, tremolite, anthophyilite. and actinolite. increasing his or her risk of developing exposure related chronic diseases. It is important for the physician to become familiar with the operating conditions in which occupational exposure to asbestos, tremolite. anthophyilite, and actinolite is likely to occur. This is particularly important in evaluating medical and work histories and in conducting physical examinations. When an active employee has been identified as having been overexposed to asbestos, tremolite, anthophyilite, and actinolite. measures taken by the employer to eliminate or mitigate further exposure should also lower the risk of serious long-term consequences. The employer .is required to institute a medical surveillance program-for all employees who are or will be exposed to asbestos, tremolite. anthophyilite,'and actinolite at or above the action level (0.1 fiber per cubic centimeter of air) for 30 or more days per year and for all employees who are assigned to wear a negative-pressure respirator. All examinations and procedures must be performed by.or under the supervision of a licensed physician, at a reasonable time and place, and at'no cost to. the employee. Although broad latitude is given to the physician in prescribing specific tests to be included in.the medical surveillance program, OSHA requires Inclusion of the following elements in the routine examination: (i) Medical and work histories with special emphasis directed to symptoms of the respiratory system, cardiovascular system. . and digestive-tract., (ii) Completion of the respiratory disease questionnaire contained in Appendix D. . (iii) A physical examination including a chest roentgenogram and pulmonary function test that includes measurement of the. employee's forced vital capacity (FVC) and forced expiratory volume at one second (FEV,). (iv) Any laboratory or other test that the examining physician deems by sound medical practice to be necessary. The employer is required to make the prescribed tests available at least annually to those employees covered; more often than specified if recommended by the examining physician; and upon termination of employment. GLEASON-001037