DETERMINANTS OF THE PROVISION OF ETHYLENE-OXIDE MEDICAL SURVEILLANCE IN MASSACHUSETTS HOSPITALS

An in-depth survey of ethylene oxide (EtO) health and safety was condu cted in Massachusetts hospitals (n = 92) to investigate the determinan ts of the provision of medical surveillance for EtO exposure. We have evaluated the relationships between provision of EtO medical surveilla nce and (1) activating OSHA-specified triggers for providing EtO medic al surveillance (2) worker training on EtO health and safety, and (3) various public policy organizational, group, and individual characteri stics. Among the Occupational Safety and Health Administration's (OSHA ) five specified triggers for provision of EtO medical surveillance, o nly accidental worker exposures were related to provision of surveilla nce (RR = 2.56, P < 0.001). Exceeding the Action Level for 30 or more days, one of OSHA's EtO triggers that is also used in a number of othe r standards, was not related to provision of surveillance (RR 0.84, P = 0.714). Reports of coverage of EtO medical surveillance issues in wo rker training were also correlated with the provision of Eto medical s urveillance (RR = 3.68, P < 0.001), supporting OSHA's premise that wor ker training plays an important role in medical surveillance implement ation. The presence of detailed written EtO medical surveillance polic ies was positively related to the provision of EtO medical surveillanc e (RR = 1.81, P < 0.001). The relationships between these potential de terminants and provision of medical surveillance were also validated i n multivariate analyses. implications for improvement of OSHA medical surveillance implementation through revised trigger schemes, improved worker training efforts, and other measures are discussed. Findings ar e relevant to the future development of medical surveillance and expos ure monitoring policies and practices in both substance-specific and g eneric contexts.