Exposure databases and exposure surveillance: promise and practice.

Based on recent developments in occupational health and a review of industry practices, it is argued that integrated exposure database and surveillance systems hold considerable promise for improving workplace health and safety. A foundation from which to build practical and effective exposure surveillance systems is proposed based on the integration of recent developments in electronic exposure databases, the codification of exposure assessment practice, and the theory and practice of public health surveillance. The merging of parallel, but until now largely separate, efforts in these areas into exposure surveillance systems combines unique strengths from each subdiscipline. The promise of exposure database and surveillance systems, however, is yet to be realized. Exposure surveillance practices in general industry are reviewed based on the published literature as well as an Internet survey of three prominent industrial hygiene e-mail lists. Although the benefits of exposure surveillance are many, relatively few organizations use electronic exposure databases, and even fewer have active exposure surveillance systems. Implementation of exposure databases and surveillance systems can likely be improved by the development of systems that are more responsive to workplace or organizational-level needs. An overview of exposure database software packages provides guidance to readers considering the implementation of commercially available systems. Strategies for improving the implementation of exposure database and surveillance systems are outlined. A companion report in this issue on the development and pilot testing of a workplace-level exposure surveillance system concretely illustrates the application of the conceptual framework proposed.