BIOLOGICAL MONITORING

A. Siswanto
2010
• The goal of preventive occupational health
is to reduce worker exposures to potentially
harmful agents to levels which, to the best
of our knowledge, do not cause any adverse
or toxic effects.
• One step in this process is the assessment
of exposure.
Host Factors that Affect/Response
to Toxic Agent

Chemical hazards
Gender Genetic
Factors

Medical Age
History

Race
• Consideration should be given to whether the
controls in place can be adequately evaluated by
environmental monitoring without the need
for health surveillance.
• It is not possible to apply the same criteria to all
substances, but as a general rule where the
exposure is less than 10% of the Workplace
Exposure Standard, and the major route of
exposure is inhalation, then biological monitoring
may not be necessary.
Tujuan:
1. Mengendalikan faktor lingkungan kerja
2. Pemeriksaan berkala tingkat pemaparan di
lingkungan kerja
3. Identifikasi potensi bahaya yg berasal dari
sarana, bahan mentah, proses produksi dan
cara kerja yg baru
4. Memantau tingkat pemaparan tenaga kerja
5. Mengevaluasi efektivitas pengendalian
lingkungan kerja
The EEC/NIOSH/OSHA working group define
health surveillance as : “ the periodic medico-
physiologic examinations of exposed workers
with the objective of protecting health and
preventing disease. The detection of established
disease is outside the scope of this definition.
Health surveillance
is the monitoring of
individuals with the
purpose of identifying
changes in health status
due to occupational
exposure to workplace
hazards.
• Health surveillance and workplace exposure
should not be thought of in isolation,
however, and the best combination should be
applied to ensure that the exposure to the
hazard is controlled and unlikely to result in
harm. Further more specific information is given
in the guidelines for individual substances.
• Before any surveillance program is developed it
is recommended that advice and
recommendations be sought from a specialist in
occupational health.
WHO MAY REQUIRE HEALTH
SURVEILLANCE?
Health surveillance is required for employees
having:
(a) A risk to health from one or more of the
hazardous substances or processes
(b) Exposure to a substance hazardous to
health for which:
(i) An identifiable disease or health effect
may be related to the exposure;
(ii) There is a reasonable likelihood that the
disease or health effect may occur under
the particular conditions of work; and
(iii) There are valid techniques for detecting
indicators of the disease or effect.
The types of procedure which may be
followed include:
• Biological exposure monitoring;
• Biological effect monitoring;
• Medical tests;
• Medical examination;
• A review of present and past medical
and work history;
• A review of medical records and occupational
exposure;
• Self-reporting of symptoms; or
• Examination by a suitably qualified person
(e.g, an occupational health nurse).
• These procedures are not mutually exclusive,
and the results from one procedure may
indicate the need for another.
Monitoring was defined by a seminar sponsored
by the EEC (European Economic Community),
NIOSH (National Institute for Occupational Safety
and Health), and the OSHA (Occupational Safety
and Health Administration) as : a systemic or
repetitive health-related activity designed to lead,
if necessary, to corrective action.
Monitoring is to survey regularly
all measures which are used to
control occupational exposure in
the workplace.
 Monitoring

Biological
Air Monitoring
Monitoring
ENVIRONMENTAL
MONITORING
The determination of the concentration of toxic
substances in the air of working environments.
Environmental monitoring ---- is essential for
the surveillance of hygiene conditions and for
a preliminary identification of risk, but it does
not permit an accurate evaluation of the
occupational exposure of individual workers.
Environmental monitoring account neither
for skin absorption, accumulation, the use of
personal protective equipment, differences in
physical activity, working habits, and personal
hygiene nor for non-occupational exposure,
while biological monitoring accounts for all of
these.
• To choose the proper personal protective.
• To evaluate the effectiveness of engineering
controls.
• To ensure compliance with regulatory
standards.
• To establish regulated areas following a spill
or leak.
• To avoid future litigation.
• Personal samples are those collected on
individuals to estimate personal exposures.
• If the sampling strategy has been designed to
collect representative samples for a job
operation, these personal sampling results
will yield the most reliable estimates of exposure.
• Personal samples are generally collected in what
is called the breathing zone, which has
recently been redefined as a hemisphere
forward of the shoulders with a six to nine inch
radius.
• Area samples are collected to estimate
exposures at different locations and areas
throughout the workplace.
• If the workplace exposures are well
characterized by location, it is possible to
estimate the average worker's exposure by
determining the person's movements and
activities throughout the workplace.
• An advantage of area monitoring is that
the industrial hygienist is able to
understand the daily fluctuations in
levels of airborne contaminants at each
location and is able to develop an
understanding of the contribution of
each part of the process to workplace
exposures.
• They offer limits for less than 10% of the
chemicals in widespread commercial use.
• They evaluate only inhalation exposures.
• They are often out of date because
updates take years.
• They may be based on inadequate research.
• The may not adequately protect sensitized
workers.
• The may not be representative of the entire
working population.
• They do not account for multiple exposures that
are additive or synergistic.
• The sampling results reflect conditions on one
day and may miss excursions or peak
exposures.
• At times, they represent a political compromise
rather than a scientifically-based guideline.
• They do not consider off-the-job exposure.
BIOLOGICAL MONITORING
• Dengan dilakukannya monitoring biologis,
maka dapat diukur dan diakses tingkat
paparan yang aman;
• Parameter yang digunakan adalah
parameter biologis.
• The best measure of an individual's exposure
to a chemical is derived from biological
monitoring.
• This type of monitoring involves the analysis
of body fluids, tissues or exhaled breath for
contaminants or metabolic products of the
contaminants.
• Biological monitoring is particularly useful for
estimating exposure to chemicals that are
easily absorbed through intact skin or have
low vapor pressures and consequently, lower
potential for inhalation.
• In such cases, simple airborne monitoring
provides no information about whether an
individual has been exposed by the dermal
route or how the contaminant has been
absorbed.
• Biological monitoring can assist the industrial
hygienist and engineer in recommending
personal protective equipment or other control
measures which may be appropriate for an
operation.
Biologic monitoring is defined as : the
measurement and assessment of agents or
their metabolites either in tissues, secreta,
excreta, expired air or any combination of
these to evaluate exposure and health risk
compared to an appropriate reference.
• Where there is exposure to a substance
which presents a risk to health, or there
is a reasonable likelihood that exposure
to a substance may cause disease or
health effects, consideration needs to
be given to :
• The population at risk, and in particular the
presence of a susceptible group;
• The variability and effectiveness of control
of occupational exposure to the substance;
• The potential routes of exposure; and
• The relationship between the anticipated total
exposure and the current OEL (Occupational
Exposure Limit or Biological Exposure Index.
Biological exposure monitoring reflects
absorption, not harmful or non-reversible
effects. As part of a health surveillance
program it is used to:
a. Provide information on the performance
of the controls with respect to absorption
of the substance;
Biological Exposure Monitoring (cont’d)

b. Assess absorption of hazardous substances

into the body by measuring their concentration
or those of their breakdown products;
c. Identify individual workers who are absorbing
excessive amounts of a hazardous substance.
d. This is to enable their protection to be increased,
or their removal from exposure until the
concentration of the biological marker returns to
a satisfactory level.
Biological Exposure Monitoring

The methods commonly used measure the

concentration of the substance or its
metabolite in urine, blood, exhaled breath,
or sweat. In situations where there is
significant skin absorption or ingestion,
• Biological monitoring may be the only
way of confirming the adequacy of controls.
• Even where the exposure is predominantly
through inhalation, and hence can be
quantified using environmental monitoring,
biological monitoring may provide additional
information.
• For substances with a relatively long half life
in the biological medium that is used for the
test, the result will reflect the average
exposure over time.
• The size of airborne particles, their chemical
state and the work load, hence the breathing
and blood circulation rate of the individual, all
influence the relationship between the airborne
concentration of the contaminant and the
amount the person absorbs.
• Blood lead monitoring is routinely used as
an estimate of the lead absorbed by workers
in a number of processes.
• The results are used to determine if controls
need to be improved and when to remove
anyone with excessive absorption from the
job until their blood lead levels return to an
acceptable value.
• It is generally accepted that blood lead
monitoring provides more information on the
risk presented by the cumulative poison than
an environmental monitoring program.
If the results of biological monitoring reveal that
the confirmed blood lead level is at or above :
a. 50 ug/dL for males and females not of
reproductive capacity
b. 50 ug/dL for males of reproductive capacity;
c. 20 ug/dL for females of reproductive capacity;
d. 15 ug/dL for females who are pregnant or
breast feeding;
the employees should immediately be removed
from the lead-risk job to a job that is not a lead-
risk job.
• Once every six months if the most
recent blood lead level is less than :
a. 30 ug/dL, for males and females not
of reproductive capacity.
b. 30 ug/dL for males of reproductive
capacity.
• Once every three months if the most recent
blood lead level is :
a. 30-39 ug/dL, for males and females not of
reproductive capacity.
b. 30-39 ug/dL, for males of reproductive capacity.
c. 10 ug/dL, for females of reproductive capacity.
• At least once every six weeks if the most
recent blood lead level is at or above :
a. 40 ug/dL, for males and females not of
reproductive capacity.
b. 40 ug/dL, for males of reproductive capacity.
c. 10 ug/dL, for females of reproductive capacity.
• Biological effect monitoring involves
the measurement of a biological change
that is non-adverse and reversible.
• It should not be confused with medical
monitoring that aims to measure early
signs and symptoms of adverse effects.
Biological Effect Monitoring

• Biological effect monitoring is theoretically

an ideal tool in preventing the development
of disease related to chemical exposure,
as it has the potential to take into account
individual susceptibility in contrast to
exposure monitoring.
Biological Effect Monitoring

Cholinesterase monitoring for workers exposed to

organophosphate pesticides and markers of lead
uptake that relate to its effect on hemoglobin
synthesis, such as zinc protoporphyrin (ZnPP) and
delta-aminolevulinic acid dehydratase (ALA-d),
are examples of the few commonly applied
biological effect monitoring techniques.
• Exposure to organophosphate pesticides
reduces the enzyme cholinesterase in the red
cells and plasma.
• A lowering of blood cholinesterase levels in
itself is not a harmful effect, but the blood result
reflects enzyme levels at more critical sites and
absorption of the pesticide.
• Gaining equivalent information from
environmental monitoring would be difficult —
especially considering that skin absorption is
significant for pesticide workers.
• These viewpoints must be weighed against
the advantages of biologic compared with
environmental monitoring.
• Environmental monitoring accounts neither
for skin absorption; accumulation; the use
of personal protective devices; and
differences in physical activity, working habits,
and personal hygiene nor for non-occupational
exposure, while biologic monitoring accounts
for all of these.
• A biologic monitoring program requires
the workers’ informed consent.
• Every action taken on the basis of the
results of the monitoring must be in the
interest of the worker, and the results
must not be made public without the
consent of the workers involved.
• Biological monitoring consists of an
assessment of overall exposure to
chemicals that are present in the workplace
through measurement of the appropriate
determinant(s) in biological specimens
collected from the worker at the specified
time.
• Biological monitoring should be considered
complementary to air monitoring.
• Biological monitoring should be used to
substantiate air monitoring, to test the efficacy
of PPE, to determine the potential for absorption
via the skin and the gastrointestinal system, or to
detect non-occupational exposure.
• When biological monitoring data are interpreted,
intra-individual and inter-individual differences in
tissue levels of determinants occurring at the
same exposure conditions must be considered.
• The determinant can be the chemical itself
or its metabolite(s), or a characteristic
reversible biochemical change induced
by the chemical.
• The measurement can be made in exhaled
air, urine, blood, or other biochemical
specimens from the exposed employee.
Kinetics of absorption and excretion, the
half-lives of harmful industrial agents may be
divided into three categories :
a. Short (several hours) e.g., furfural, phenol,
toluene and xylene.
b. Medium (several tens of hours) e.g.,
perchloroethylene and trichloroethylene.
c. Long (weeks or even month) e.g. mercury
and lead.
Meaningful biologic monitoring presupposes
that four conditions be met :
1. The chemical substance and/or its metabolite
are present in some tissue, body fluid or
excretion suitable for sampling.
2. Valid and practical methods of analysis and
sampling are available.
3. The measurement strategy is adequate (the
samples are representative).
4. The result can be interpreted in a meaningful
way.
With biological monitoring, information can
be obtained that would not otherwise be
available, i.e. :
a. On the evaluation of absorption and/or
exposure over a prolonged period of time.
b. On the amount of a substance absorbed as a
result of movements within the working
environment or of accidental causes, which
often cannot be checked.
c. On the amount absorbed by the organism via
various routes.
Biological Monitoring (Cont’d)

d. On the evaluation of the over-all exposure, as

the sum of different sources of contamination,
which may also exist outside the working
environment.
e. On whether the subject has been exposed to a
risk which could not be proven in any other
way and in some cases, when.
Biological monitoring (cont’d)
f. On the amount absorbed by the subject,
taken as an individual, as related not only to
his workplace, but also to climatic factors, the
subject’s particular way of withstanding
physical effort, age, sex, individual genetic
characteristics, the functional condition of the
organs responsible for biotransformation
and elimination processes, etc.
Biological monitoring is performed by the
determination, on biological samples of exposed
organism, of the exogenous agents, their
metabolites and the metabolic effects they produce.
These determinations are used as biological
indicators. The biological samples where the
indicators may be determined consist of :
a. Blood, urine, saliva, sweat, feces
b. Hair, nails
c. Expired air
Biological indicators may be indicators of internal
dose or indicators of effect. The indicators of
internal dose can be further divided into :
a. True indicators of dose, that is capable of
indicating the quantity of the substance at the
sites where it exerts its effect (that is still a
theoretical problem in industrial toxicology).
 b. Indicators of exposure which can provide an
indirect estimate of the degree of exposure,
since the level of the substance in biological
samples is closely correlated with the levels of
environmental pollution.
c. Indicators of accumulation that can provide
an evaluation of the concentration of the
substance in organs and/or tissues from which
the substance, once deposited, is only slowly
released.
The conditions necessary for successful biological
monitoring can be thus summarized as follows :
a. The existence of indicators.
b. The existence of sufficiently accurate,
sensitive and specific analytical methods
that will guarantee technical reliability in the
use of these indicators.
c. The possibility of using readily obtainable
biological samples on which the indicators
can be measured.
d. The existence and knowledge of dose
effect and dose-response relationships.
TIME OF SAMPLING
In carrying out a biological monitoring program, it
is indispensable (sangat diperlukan) to know
exactly what the characteristics and behavior of
the indicators under study are in relation to length
of exposure, time elapsed since the beginning and
end of exposure, and other factors that may give a
false interpretation of the results obtained.
• For example, in the exposure to metals the
levels of indicators of internal dose vary with the
time interval after the end of exposure.
• Subjects with a clinical picture of lead poisoning
may show blood lead levels very close to those
of the non-occupationally exposed, when the
measurement of lead in blood is made some
time after the end of exposure.
The use of hair as a biological specimen for
the verification of exposure to metals, while
useful in monitoring the general population,
is not recommended for occupational
exposure since the sample may have
undergone external contamination and the
values obtained would not represent the
internal dose.
• Inconsistencies may be observed between
the information obtained from air
monitoring and biological monitoring for a
variety of reasons, including, but not
limited to, work-related and methodological
factors. Examples are listed below :
• Physiological makeup and health status of the
worker, such as body build, diet (water and fat
intake), metabolism, body fluid composition,
age, gender, pregnancy, medication and
disease state.
• Occupational exposure factors, such as the
work-rate intensity and duration, skin exposure,
temperature and humidity, co-exposure to
other chemicals, and other work habits.
• Non-occupational exposure factors, such as
community and home air pollution, water and
food components, personal hygiene, smoking,
alcohol and drug intake, exposure to household
products, or exposure to chemicals from hobbies
or from another workplace.
• Particle size distribution and bioavailability (the
degree to which a substance becomes available
to the target tissue after administration).
• Methodological factors, which include
specimen contamination or deterioration during
collection and storage and bias of the selected
analytical method.
• Location of the air monitoring device in relation
to the worker’s breathing zone.
• Variable effectiveness of personal protective
device.
• Because the concentration of some determinants
can change rapidly, the specimen collection
time (sampling time) is very important and must
be observed and recorded carefully.
• The sampling time is specified in the BEI and is
determined by the duration of retention of the
determinant.
• Substances and determinants that accumulate
may not require a specific sampling time.
Urine specimens that are highly dilute or highly
concentrated are generally not suitable for
monitoring. The WHO has adopted guidelines for
acceptable limits on urine specimens as follows :
creatinine concentration : > 0,3 g/l and < 3,0 g/l;
or specific gravity : > 1,010 and < 1,030.
• In exposure to organic substances, the collection
time of the biological samples becomes all the
more important in view of the different speed of
metabolic processes and consequently of the
more or less rapid excretion of the absorbed
dose.
• For example, the biological monitoring of xylene
is carried out by measuring the concentration of
methylhippuric acid in urine.
• The excretion of this urinary metabolite is
practically completed within 16 hours after the
end of exposure and the highest levels of
methylhippuric acid are found at the end of
exposure, when exposure is constant over time.
• In this case the current practice of collecting the
urine samples at the end of the shift is correct.
In the biological monitoring of trichloroethylene
(TCE) the determination of trichloroacetic acid in
the urine must be made at the end of the working
week since the solvent is metabolized rather
slowly, with a consequent accumulation process.
• When the analysis is made on spot samples,
the levels of the substances under study must
be corrected to an urinary standard specific
weight, for example 1.016 or 1.024, or
according to the creatinine content, so as to
reduce the possible wide variations in values.
• In particular, urine with a specific weight below
1.010 or higher than 1.030 or with a creatinine
concentration lower than 0,5 g/l or greater than
3 g/l should be discarded.
• The levels of some urinary metabolites or organic
substances may be influenced by exposure other
than occupational.
• For example in the case of toluene, eating prunes,
which contain benzoic acid, can give rise to a high
excretion of hippuric acid.
• Increased amounts of urinary phenols are found
after taking drugs containing phenylic groups.
Methylmercury In Fish

Brune et al (1991) have established tentative

mean reference values according to the amount
of fish consumed.
Category I (no fish consumption) : 0,2 ug/100 ml
whole blood or 0,13 ug/100 ml plasma;
Category II (< 2 fish meals/week) : 0,48 ug/100
Ml whole blood and 0,25 ug/100 ml plasma;
Methylmercury In Fish
Category III (> 2-4 fish meals/week) :
0,84ug/100 ml whole blood ;
Category IV (> 4 fish meals/week) : 4,44 ug/100
ml whole blood;
Category V (unknown fish consumption) : 0,58
ug/100 ml whole blood and 0,21 ug/100 ml
plasma.
Category III – IV : 0,47 ug/100 ml plasma.
Non Occupational Exposure
• People who don’t usually eat fish and have no
occupational exposure have mercury levels in
whole blood of below or about 5 ug/l.
• Moderate consumption of fish containing mercury
may give blood levels of 10-20 ug/l.
• In heavy fish eaters values of 100-200 ug/l or even
more may be observed.
• The general level of mercury in urine in non-
exposed subjects seems usually to be below or
about 0,5 ug/l, although much higher values have
also been reported.
The biotransformation of benzene in
rats is accelerated by administration of
phenobarbital, probably by induction of
the microsomal enzymes responsible for
metabolizing the solvent; as a
consequence the elimination of urinary
phenols is lower than would be expected
from the degree of exposure.
For the study early biological effects
resulting from the absorption of a toxic
substance, it is not only necessary to study
the alterations that occur in the critical
organ, but also to know which indicator of
effect gives the earliest possible information
on such alterations.
For example, in cadmium-exposed
subjects the determination of proteinuria
with trichloroacetic acid can reveal
tubular damage; however, the detection
of low molecular weight proteins in urine
can reveal the same effect earlier.
• In many instances, when the level of the
determinant changes rapidly or when
accumulation occurs, the sampling time is very
critical and must be carefully observed.
• The sampling time is specified in the table
according to the differences in the uptake and
elimination rates of chemicals and their
metabolites, and according to the persistence of
induced biochemical changes, as follows :
• Determinants with timing “prior to shift”
(meaning after 16 hours without exposure),
“during shift”, or “end of shift” (meaning the
last two hours of exposure) are eliminated
rapidly with a half-time less than five hours.
• Such determinants do not accumulate in the
body and, therefore, their timing is critical only
in relation to the exposure and post exposure
periods.
Sampling Time

• Determinants with timing “beginning of

workweek”, or “end of workweek”
(meaning after two days without exposure
or after four or five consecutive working
days with exposure, respectively) are
eliminated with half-times longer than five
hours.
• Such determinants accumulate in the body
during the workweek, therefore, their timing
is critical in relation to previous exposure.
• For chemicals with multiphase elimination, the
timing is given in relation to the workday
exposure (shift) as well as to the workweek
exposure.
• Determinants with timing “not critical”, or
“discretionary”, have very long elimination half-
times and accumulate in the body over years,
some for a lifetime.
• After a couple of weeks of exposure, specimens
for measurements of such determinants can be
collected any time.
 Sampling Time
Sampling time Recommended collection

Prior to shift 16 hours after exposure ceases

During shift Any time after 2 hours of exposure

End of shift As soon as after exposure ceases

End of the workweek After 4 or 5 five consecutive working

days with exposure
Discretionary (bebas At any time
untuk menentukan)
 Relationship between cadmium concentration in air and
cadmium concentration in urine (CdU) of workers exposed
in battery - making plants.
• When biological monitoring data are
interpreted, intraindividual and
interindividual differences in tissue
levels of determinants occurring at the
same exposure conditions must be
considered.
• Such differences arise on account of variation in
pulmonary ventilation, hemodynamics, (relating
to the physical aspects of the blood circulation)
body composition, efficacy of excretory organs,
and activity of enzyme systems that mediate
metabolism of the chemical.
• Multiple sampling is necessary to reduce the
effects of variable factors.
• Biological monitoring may confirm the results of
air monitoring, but where there is a discrepancy
between the results, the entire exposure
situation should be carefully reviewed and an
explanation found.
Interpretation of Data

No result is useful if it cannot be interpreted. The

better the dose-effect and dose-response
relationships are known, the higher the likelihood
for correct judgment.
Aktivitas/upaya sistematis dan repetitif
Hiperkes dan Keselamatan kerja yang
didesain untuk memberi arah bagi
dilakukannya tindakan serta bila perlu
perbaikan.
Monitoring

1. Monitoring lingkungan
2. Monitoring biologis
3. Monitoring fisik
Monitoring Fisik

96
Monitoring

Dilakukan dengan pendekatan pada

hal-hal yang bersifat fisik misalnya :
a. Kondisi fisik mesin
b. Perlakuan terhadap zat kimia
MONITORING – UNTUK
APA ?
Indikator Biologis

Zat kimia dalam media biologis yang

merupakan petunjuk dari zat kimia
dimana terhadap zat kimia tersebut
tenaga kerja terpapar.
• Darah lengkap • Gigi
• Plasma • Tulang
• Air liur • Keringat
• Urin • Tinja
• Rambut
Contoh :

• Kadar Pb darah untuk pemaparan

timah hitam/timbal (Pb).
• Kadar fenol urin untuk pemaparan
benzena.
Waktu Paruh Panjang

• Beberapa bulan sampai belasan tahun.

• Sampling sewaktu-waktu ;
• Contoh : timbal (Pb), kadmium (Cd),
dan merkuri (Hg).
Waktu paruh

Belasan jam sampai beberapa bulan;

Sampling akhir pasca shift;
Contoh: As, Cr, Co, Ni, perkloretilen,
lindan, trikloretanol
Waktu paruh pendek

• Lebih dari satu sampai beberapa jam

---------------- sampling akhir hari kerja.
Contoh : Fenol (benzena), asam
mandelat (stiren), asam metil-hippurat
(xilen), karbon monoksida (CO), CS2
(karbon dioksida), dan dikloretan.
1. Terbaik adalah darah atau urin
2. Pilihan atas tingkat kepercayaan,
kemudahan sampling, biaya dll.
3. Hanya darah : pestisida --- inhibitor
kolinesterase atau CO (COHb)
4. Hanya urin : asam mandelat (stiren)
atau metil hippurat (xilen)
1. Mungkin darah juga urin
2. Hg darah paparan kerja dan juga
dari makanan
3. Hg urin paparan kerja
4. Metil merkuri lewat tinja
Body Burden

Kandungan dalam tubuh atau body

burden adalah : banyaknya zat kimia
atau metabolitnya dalam tubuh

107
Body Burden

1. Pb disimpan dalam tulang (90%);

sisanya dalam jaringan lunak; 90% Pb
darah di sel darah merah.
2. Hg pada ginjal, hati, limpa dan tulang;
Hg organik di jaringan lemak.

108
Pemaparan-Efek

Hubungan antara tingkat paparan

suatu zat kimia dengan tingkat
efeknya secara kuantitatif terhadap
kesehatan seorang atau kelompok
tenaga kerja.
Monitoring Biologis

Efek
Respons

110
1. Zat kimia dalam tubuh menimbulkan
suatu efek yang baik, tidak buruk
atau buruk.
2. Monitoring efek tidak buruk digunakan
untuk pencegahan.
Hubungan antara tingkat pemaparan suatu
zat kimia dengan persentase tenaga kerja
dengan efek tertentu terhadap kesehatan.
Monitoring Lingkungan dan Biologis

1. Monitoring lingkungan --- eksternal,

monitoring biologis --- internal (kontak
langsung).
2. Monitoring lingkungan --- paparan
udara; monitoring biologis --- seluruh
paparan.

113
Monitoring Lingkungan dan Biologis

Monitoring biologis --- paparan udara,

absorpsi kulit, terbebasnya zat kimia yang
berakumulasi, pemakaian alat pelindung,
perbedaan kegiatan fisik, kegiatan dalam
bekerja, higiene perorangan dan
pemaparan diluar lingkungan kerja.

114
NOAEL

Kadar batas pemaparan yang tidak

menunjukkan efek /respons buruk terhadap
kesehatan tenaga kerja. (NOAEL = No
Observed Adverse Effect Level).
Variabilitas Hasil

1. Pengambilan dan analisis sampel

2. Peralatan
3. Faktor manusia
Variabilitas Hasil

Kontaminasi lingkungan :
1. Makanan, minuman atau udara : Cd,
Pb, Hg, senyawa organik DDT dll.
2. Merokok atau ada yang merokok :
benzena, CO, HCN atau Cd
1. Pengetahuan yang memadai tentang
toksikokinetik zat kimia yang bersangkutan.
2. Metode sampling yang praktis.
3. Analisis yang tidak rumit, akurat dan tidak
mahal.
4. Tidak membahayakan.
5. Akseptasi tenaga kerja.
1. Keberadaan zat kimia atau metabolitnya
dalam jaringan dan cocok diambil
sampelnya.
2. Metode sampling dan analisis yang
valid.
3. Strategi pengukuran yang baik dan
sampel representatif.
4. Interpretasi yang tepat terhadap hasil.
Standar Hygiene
1. Nilai Ambang Batas (NAB) Indonesia
2. Threshhold Limit Values (TLVs) ACGIH
3. Maximum Allowable Concentrations (MACs)
4. Standar berbagai negara (OEL = Occupational
Exposure Limit; MEL = Maximum Exposure
Limit).
1. Keduanya penting dan berperan dalam
upaya pencegahan penyakiat akibat
kerja karena paparan bahan beracun.
2. Keduanya saling mengisi/melengkapi
Indikator Biologis

• NAB untuk 722 zat kimia

• Hanya 69 zat kimia yang ada indikator
biologisnya.
• Monitoring lingkungan terbukti sangat
bermanfaat; Baru sejumlah kecil (<10%)
zat kimia yang ada NABnya disertai
dengan indikator biologis.
Standar pemaparan zat kimia oleh karena
pekerjaan dan atau lingkungan kerja atas dasar
kadar zat kimia atau metabolitnya dalam media
biologis sebagai pedoman pengendalian agar
tenaga kerja masih dapat menghadapinya tanpa
mengakibatkan penyakit atau gangguan
kesehatan dalam pekerjaan sehari-hari untuk
waktu tidak lebih dari 8 jam sehari atau 40 jam
seminggu.
1. Kondisi fisiologis dan kesehatan tenaga kerja
2. Faktor-faktor yang mempengaruhi
pemaparan kerja
3. Faktor-faktor diluar pekerjaan dan atau
lingkungan kerja
4. Faktor metodologis sampling/analisis
5. Lokasi penempatan alat monitoring
6. Karakteristik partikel
7. Efektivitas alat pelindung diri.
1. Atas dasar kadar zat kimia atau metabolitnya
pada populasi normal.
2. Non-kuantitatif atas dasar review atau
pendapat, sedangkan nilai spesifik tidak
dapat ditetapkan.
3. Non-spesifik; ditemukan pula pada zat lainnya.
4. Nilai semi-kuantitatif yang tidak ada
kesepakatan mengenai interpretasinya.
Pemeriksaan medis-fisiologis secara
berkala pada tenaga kerja yang terpapar
bahan kimia dengan tujuan untuk
perlindungan kesehatan dan pencegahan
penyakit.
Deteksi gangguan mekanisme homeostasis dan
kompensasi pada waktu perubahan biokimiawi,
morfologis dan fungsional masih dapat pulih
sebelum timbulnya gejala dan tanda penyakit.
(homeostasis : a tendency to stability in the
normal physiological states of the organism)
Contoh :
1. Aktivitas kolinesterase untuk senyawa
organofosfat
2. Uji kapasitas ventilasi paru untuk bissinosis
3. Kadar timah darah pada keracunan timbal
4. Asam triklor-asetat urin bagi pemaparan
trikloretilen
5. Fenol urin untuk pemaparan benzen
6. Pemeriksaan darah untuk pengaruh bahan
yang berefek hematopoitis
• SNI 19-032-2005
• Nilai Ambang Batas Faktor Kimia
di Udara Tempat Kerja
1. Monitoring biologis dan monitoring
lingkungan sangat perlu untuk
diselenggarakan;
2. Monitoring biologis dan monitoring
lingkungan saling melengkapi.
3. Monitoring biologis telah dikaitkan
dengan monitoring lingkungan;
4. Dari 722 zat kimia yang ada NABnya,
69 zat kimia dinyatakan perlu Indeks
Pemaparan Biologis (IPB);
5. Pada SNI tentang NAB tidak dinyatakan
nilai IPBnya;
6. NAB adalah standar lingkungan atau
standar higiene, sedangkan monitoring
biologis adalah standar medis;
7. Terdapat aneka persyaratan untuk
menerapkan monitoring biologis terutama
quality assurance;
8. Tantangan untuk kalangan riset untuk
meneliti IPB dengan semua aspeknya;
9. Para praktisi dapat memulai
menerapkan monitoring biologis jika
tersedia sumber daya yang memadai.
SEKIAN DAN TERIMA KASIH