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5 March 2013
Occupational Hygiene in the 21st Century
Andy Gillies, MSc, CFFOH Past President, BOHS MD, Gillies Associates Limited
5 March 2013
Acknowledgements
I am indebted to the following people who have provided examples, slides and other help in the development of this talk: • Sharon Brunt • Adrian Hirst • Kate Jones • Trevor Ogden • Martin Stear • Alvin Woolley
5 March 2013
Agenda
• The changing nature of Occupational Health • Where does Occupational Hygiene fit in the H&WB
multi-disciplinary team? • The enigma of Exposure Control:
– Dust (L.E.V.) – Occupational Cancer (chemical carcinogens) – Noise
• Challenges for the Occupational Hygiene profession
5 March 2013
A brief introduction to BOHS
• A multidisciplinary, learned and professional society established since 1953
• The voice of the occupational hygiene community in the UK
• An unrivalled source of information and expertise for members and non-members alike
• An examining board, through the Faculty of Occupational Hygiene, awarding qualifications in occupational hygiene and allied subjects
• For anyone with an interest in occupational hygiene, or a need for our services
5 March 2013
The Royal Charter
BOHS was granted the Royal Charter in December 2012 • All BOHS members benefit from being members of a Royal Charter
Society • Increased Society visibility brings greater influence and
responsibility to ‘live up to’ the Charter
Individual Chartered Status • Diploma qualified, practising Members and Fellows of Faculty
entitled to use ‘Chartered Occupational Hygienist’ and/or CMFOH/CFFOH.
Charter
5 March 2013
Changing nature of OH “All workmen should be told something of the danger of the material with which they come into contact and not be left to find out for themselves – sometimes at the cost of their lives” Sir Thomas Legge (first Medical Inspector of Factories)
“While nanomaterials clearly provide unique technical and commercial opportunities, the rapid increase in their use raises questions regarding their potential effects on health and environment. There is a need to adequately assess and manage the potential risks of these new forms of materials…” ECHA website
5 March 2013
New world of work
1970’s
• Heavy manufacturing, arduous manual
work – steel making, shipbuilding, etc. • Large coal mining sector • Workforce predominantly male, and
mostly full-time • HSW Act 1974
2010’s
• Decline in manufacturing – increase in
office work • Fewer large companies, lots of SME’s • Growth areas - Business services,
Healthcare & Biosciences, Nanomaterials.. • Ageing workforce • Part-time work, portfolios • Homeworking, Work/life balance • Increased nos. of women in workforce • Chronic, low level exposures
5 March 2013
• Exposures have generally reduced through better: – Regulation / enforcement – Understanding / awareness of
health risks – Attitudes to health risks – Engineering controls – PPE – etc.
Trends in exposure & disease
5 March 2013
• Health – Stress – 221,000 new cases – Musculoskeletal – 141,000 new cases – Cancers – 8000 deaths, 13,000 new cases – Respiratory disease – 7,000 new cases – Skin disease – 40,000 new cases – NIHL – about 20,000 new cases – HAVs – 1500 new claims for IIDB
Health Statistics – 2011/12
Ill health accounts for 43% of the health and safety incidents, 84% of the related sickness absence and over 99% of the work-related deaths each year
HSE: At-a-Glance Guide to Health and Safety Statistics, 2011/12, http://www.hse.gov.uk/statistics/at-a-glance.pdf .
The total cost of work-related injury and ill-health is estimated to be £13.4bn per year, excluding cancer (2010/11).
5 March 2013
Health and Wellbeing at Work – a team approach
Physiotherapy
Occupational medicine
Occupational psychology
Ergonomics
Safety professionals
Epidemiology
Occupational Hygiene
Human resources
Process Engineering
No “top dog” – shared goals, shared success
5 March 2013
Occupational Health
Preventing work-related
illness
Checking people are fit to work
Promotion of good health
OCCUPATIONAL HYGIENE
5 March 2013
Occupational Hygiene
• Anticipate
• Recognise
• Evaluate
• Control
• Manage
The unique scientific discipline that protects people against health risks from exposures in the work place
5 March 2013
The Occupational Hygienist skills set
• Anticipation and prevention of exposure • Quantifying exposures, understanding how and why
exposure arises • Practical control measures • Risk communication
A rigorous scientific approach to identify and control
the causes of workplace ill-health; a fusion of ‘individual’, ‘technology/workplace’ and
‘management’ approaches
5 March 2013
Enigma of Exposure Control A wealth of experience, knowledge and engineered solutions, but…
OCCUPATIONAL CANCER
NOISE
DUST
5 March 2013
Control of Exposure
HIERARCHY OF CONTROL
COSHH PRINCIPLES OF GCP a) Minimise emissions at source
b) All relevant routes of exposure
c) Controls proportionate to the health risk
d) Most effective and reliable option
e) Use suitable PPE in combination with other controls
f) Check and review regularly g) Inform and train employees h) Do not increase overall risk
to health and safety
5 March 2013
BOHS Conference 2005
Workshop - “Why good practice is not universal: barriers to implementation”
Most barriers are “institutional”, not “hardware” (barriers of perception rather than resources)
Top 5 reasons for inaction: • No history of health problems • Lack of competent people • Low profile of health issues in the company • Lack of communication • Poor understanding of health risks
5 March 2013
DUST • 1000’s of workers contract
respiratory disease each year: – Occupational Asthma, 148 new cases in
2011/12 – Pneumoconiosis: hundreds of cases per
year – Cancer: thousands of deaths and new
cases per year – ~4000 Chronic obstructive pulmonary
disease (COPD) deaths per year from work – At least 4000 deaths from asbestos-related
disease each year – 35,000 self-reported breathing or lung
problems caused or made worse by work EACH YEAR
• Dust exposure is common in many workplaces today
HSE: At-a-Glance Guide to Health and Safety Statistics, 2011/12, http://www.hse.gov.uk/statistics/at-a-glance.pdf .
5 March 2013
LEV – the obvious solution?
• Unfortunately NO… – Poor design – Poor installation – Lack of maintenance – Not used properly
The main problems are:
• Poor understanding of risk • Over-optimism about LEV
effectiveness • Employers often mislead & mis-sold
inappropriate LEV systems • LEV hood not matched to process and
emission source • LEV effectiveness not considered
during commissioning (if done at all!) • LEV not checked and maintained
regularly or thoroughly • Thorough Examination and Test of
LEV is often inadequate
5 March 2013
Dust - understand the source(s)
Now you see it
Now you don’t
•Without a good understanding of processes and sources, and how airborne contaminants move in air, LEV design is hit-and-miss and usually fails to protect
5 March 2013
One of several problems: Employers sold inappropriate and expensive LEV systems that don’t work
5 March 2013
ECEL-database Fransman et al. Ann Occup Hyg, 2008
Fransman et al, “Development and evaluation of an exposure control efficacy library”, Ann.occup.Hyg., 52(7), 567-576, 2008
“...there is a huge range in the “true effectiveness” of localized
controls and (that) their effectiveness in the work
environment is usually lower than the measured experimental
effectiveness.” (Fransman et al, “Development of a mechanistic model for ART”)
• Great variability in efficacy of LEV
• In some cases LEV made exposure worse!
5 March 2013
Case study – pharmaceutical manufacture
• Manufacturing tablets – range of APIs
• A number of powder handling processes:
– Dispensing, granulation, compression, packing
– Laboratories
• Qualitative assessment of emission sources
• No exposure data • Commitment in principle to
improving engineering controls
5 March 2013
Case study – what was done
• Step 1: detailed review of emission sources carried out by the company using process flow schematics
• Step 2: task-based exposure monitoring in priority locations
• Step 3: task analysis and development of engineering control options (including “quick fix” solutions)
• Step 4: development and delivery of tailored training programme, including dust visualisation videos
• Step 5: exposure monitoring strategy
5 March 2013
Dust visualisation • Adaptation of process room to
create suitable lighting conditions • Use of dust lamp and digital
videocam • Operators themselves carried out
typical tasks (scooping powders, bag tipping, etc.)
• Simulation of “normal”, “careful” and “deliberately rough” handling techniques using surrogate powder
5 March 2013
Case study – lessons learned
• Need a Champion – in this case, EHS Manager • Systematic approach to assess risk, identify principal emission
sources, and quantify exposures • Dust visualisation can be a powerful tool – “Wow factor” • Most important factor was alignment of OH with production
and quality concerns
5 March 2013
A strategy for effective dust control
• Recognise the problem – Understand the health risks from the materials you are handling – Understand your process, identify emission sources, consider
exposure potential
• Evaluate the exposure – Assess exposure potential from each task – The whole job – not just the main activity
• Control – Apply the hierarchy (Prevent, Eliminate, etc.) – Involve, motivate, stimulate; Management and Workers – Measure your performance
5 March 2013
OCCUPATIONAL CANCER • ~8000 occupational cancer
deaths/year in UK (compared with ~3000 RTA fatalities, and 171 deaths from accidents at work)
– ~50% due to Asbestos (mesothelioma [2321 cases] + lung cancer)
– Other significant causes include crystalline silica, mineral oils, diesel engine exhausts (DEEs), shift work, solar radiation
• Current deaths reflect historic exposures. Estimates of future cancer burden are needed to set priorities for action today to reduce exposure.
"Taken from CancerHelp UK, the patient information website of Cancer Research UK: http://cancerhelp.cancerresearchuk.org".
5 March 2013
The causes of cancer
• ENVIRONMENT – the majority of cancers are due to lifestyle and environmental factors
• OCCUPATION – exposure to carcinogens in the workplace accounts for 5.3% of all cancers in the UK in 2005 (8% men, 1.5% women) *
• GENETIC – most cancers are non-hereditary, but 5-10% are caused by an inherited genetic defect (e.g. breast cancer)
* Rushton et al, BJM (2010) 102, 1428-1437; “Occupation and cancer in Britain”
Gil
5 March 2013
Carcinogens IARC review of carcinogens (2010) identified more than 400 substances/mixtures/exposure circumstances that may be carcinogenic to man, and many of them are found in the workplace: • 107 Group 1 (proven human
carcinogens) • 58 Group 2A (probable human
carcinogens) • 249 Group 2B (possible human
carcinogens)
First recorded case of cancer caused by work was by Percival Pott in 1775 – scrotal cancer in chimney sweeps
“It is a disease which always makes its first attack on, and its first appearance in, the inferior part of the scrotum”
5 March 2013
Can occupational cancer be prevented? • Is it possible?
No, but… …it is realistic to aim at reducing exposure to chemical carcinogens at work to such low levels that the risk of developing cancer would become negligible. “BOHS believes that with appropriate focused efforts almost all occupational cancers could ultimately be prevented” (Press Release, 7/12/2011)
5 March 2013
Trends in exposure & disease
Cherrie JW, Van Tongeren M, Semple S. Exposure to Occupational Carcinogens in Great Britain. Ann Occup Hyg 2007 51: 653-664.
5 March 2013
PRIORITIES – future burden
CARCINOGENS • Asbestos – construction industry,
maintenance & demolition • Diesel Engine Exhausts (DEE) – drivers,
mechanics, car park attendants • Crystalline silica – construction work, brick
making, foundries • Mineral oils – metal workers, engineering,
printing • Painters – commercial & industrial
painters, artisans • Welders – engineering, fabrication • Solar radiation – outdoor work (NMSC) • Radon – naturally occurring radioactive
gas • Shift work – nurses, flight attendants,
marine telephone operators
KEY SECTORS • Construction – asbestos, DEE, silica, solar
radiation • Personal & Household services (incl. repair
trades, laundries, dry cleaning, domestic services, hairdressing, beauty services) – asbestos, (ETS), DEE, soots, perchloroethylene
• Land transport (railways, roads, pipelines) – DEE, asbestos
• Mining – silica, asbestos, DEE, solar radiation
• Public administration & defence – (ETS), solar radiation
• Wholesale & retail trades (incl. restaurants,
hotels) – (ETS), asbestos, radon • Farming – dioxins, non-arsenical
pesticides, solar radiation
5 March 2013
Respirable Crystalline Silica
• Exposure to crystalline silica in respirable size range may cause lung cancer after heavy and prolonged exposure.
• Silicosis and COPD are also significant health risks. • Widespread exposure - quarries, mines, stonemasons,
foundries, block cutting, construction/demolition, brick making, pottery, steel and glass manufacture…
• Estimated >100,000 workers exposed to RCS. • WEL reduced to 0.1 mg/m3 in 2006. • “Silica Essentials” guidance sheets published by HSE. • Exposure reduction through automation, choice of
process parameters (e.g. cut speed), (partial) enclosures and LEV, wet suppression, etc.
5 March 2013
Welders
• Exposure to welding fumes and UV radiation is linked to lung cancer and eye melanoma.
• Significant safety and electrical risks. • Welding fume components vary depending on
process, consumables and work piece; can include known carcinogens such as Cr and Ni.
• Estimated >500,000 workers perform welding work in UK. Widespread use in most sectors of industry.
• “Welding essentials” guidance sheets published by HSE
• Exposure reduction through alternative jointing methods, choice of welding process, automation, use of LEV…
5 March 2013
Diesel Engine Exhaust (DEE) • Diesel engine exhaust emissions are a complex
mixture of many components. Respirable elemental carbon is a proxy used to quantify exposure.
• Diesel Exhaust in Miners study (“DEMS”) in USA; findings recently published (Feb. 2012). More than 12,000 workers in eight non-metal mines, 50 year period of study (1947 – 1997). Showed a strong relationship between exposure to DEE and lung cancer.
• Wide use of diesel engines at work. Exposure greatest in enclosed workplaces, especially underground mines
• Exposure reduction through separation, use of air-conditioned cabs, low emission diesel engines…
• More exposure data to quantify the risk • Improved education and awareness of risk
5 March 2013
Conquering occupational cancer
Elements needed for effective exposure reduction to carcinogens:
• Recognition of the cancer risk • A good understanding of the main risk factors for
development of the disease • Better knowledge of exposure and dose-response
relationships • Established and validated control measures • Effective enforcement
A determination to ELIMINATE WORK-RELATED CANCER
5 March 2013
NOISE • >1 million workers exposed to
noise levels that puts their hearing at risk
• ~500,000 people in UK with NIHL * • ~20,000 new cases (caused or
made worse by work) each year • Most cases found in Energy &
extraction, Water supply, Construction, and Manufacturing sectors
• Noise damage is irreversible – there is no cure
* Estimate based on 1997/98 figures
Source: HSE Health & Safety Statistics 2011/12
5 March 2013
Noise control options • Selection of quiet equipment,
processes • Design, planning, layout • Control at source • Materials handling • Enclosures, Barriers, Cladding • Silencers, Attenuators • Vibration control • Room treatment
5 March 2013
Noise control at source
Examples… • Low noise motors (up to 10
dBA quieter) • Centrifugal fans (maximum
fan efficiency = minimum fan noise)
• Damping material (e.g. SDS) to reduce vibration
• Smooth ducts and pipes • Plastic mallets!
5 March 2013
Example: reducing air noise from pneumatic drum pump
• Drum pump used to transfer liquids
• Pump normally operated at 75 p.s.i. for around 5 minutes; noise at ear = 91 dBA
• Reducing air pressure to 30 p.s.i. reduced noise level to 79 dBA with minimal drop in liquid transfer flow rate
Noise reduction of 12 dBA
5 March 2013
Sound Solutions
• NIHL is 100% preventable • Assessment of exposure is
crucial starting point • There are many low cost,
quick-fix solutions available
• Control at source, but suitable hearing protection is vital too
5 March 2013
21st Century Challenges for OH
• Who pays? – Occupational Hygiene, and all H&WB disciplines, must
become integral functions of the business/organisation, not peripheral compliance departments
– Demonstrate the “business case” (e.g. Park Health, economic benefits of reduced incidence of work-related ill-health attributed to in-house Occupational Hygiene service, calculated return on investment of £74 for each £1 spent*)
– Develop sensible performance metrics (KPI’s) (difficult to do for long latency disease)
* Tyers et al, IES, “Occupational Hygiene at the Olympic Park and Athletes Village – can workplace health management be cost-effective?” report 497, 2012
5 March 2013
21st Century Challenges for OH
• New hazards – “Chemical cocktails” (Complex aetiology of work-related ill-health, multiple causes, mixtures may require a new toxicology paradigm)
– Better data on occupational disease (Improved clinical and epidemiological data needed; good quality exposure data often lacking)
– Engineered nanoparticles (Dr Anil Adisesh of HSL will be addressing this topic later)
– Don’t overlook traditional hazards – they’re still here!
5 March 2013
21st Century Challenges for OH
• Risk communication – Public and Media interest is growing (how the media promote public misunderstanding of Science, using social media channels, Dr Ben Goldacre – “Bad Science”)
– Communicating risk in simple ways (worker understanding and motivation is crucial to exposure control, human factors and behavioural safety (health), work/home exposures – a continuum of risk)
– Risk = Hazard + Outrage *
* Peter Sandman, http://www.psandman.com/