Preventing Chronic Beryllium Disease through Exposure Recognition and Control Training for Beryllium Exposed Workers in Aluminum Smelters Training Developed

Preventing Chronic Beryllium Disease through

Exposure Recognition and Control

Training for Beryllium Exposed Workersin Aluminum Smelters

Training Developed by:

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Disclaimers

• This material was produced under grant number SH-20996-SHO from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U. S. Government.

• This training is not intended to replace site or company specific training on the recognition and control of beryllium hazards in the workplace.

• Photos shown in this presentation may depict situations that are not in compliance with applicable OSHA/safety requirements.

• It is the responsibility of the employer and its employees to comply with all pertinent OSHA/safety rules and regulations in the jurisdiction in which they work.

Definitions• Microgram (µg)

– A small unit of weight– Equal to 1/1000 of a milligram (mg)– 1 grain of salt = 100 µg

• Beryllium Exposure– Inhalation of beryllium particles– Skin contact with beryllium particles

• Beryllium Sensitization (BeS)– An allergy to beryllium

• Chronic Beryllium Disease (CBD)– Lung disease in some people with BeS

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Outline

• Introduction to OSHA• Overview of beryllium• Health effects of beryllium• Recognizing and controlling

beryllium exposure• Medical surveillance (routine

medical testing of workers for beryllium health effects)

Introduction to OSHA

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What is OSHA?

• Occupational Safety and Health Administration

• Government agency within the U.S. Department of Labor

• Responsible for worker safety and health protection

• Created in 1970 by the Occupational Safety and Health (OSH) Act

• OSH Act allows states to take responsibility for implementing OSH Act providing their regulations are at least as stringent as Federal OSHA

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What does OSHA do?

• Requires employers to implement programs to reduce workplace safety and health hazards

• Investigates workplace fatalities or catastrophic accidents

• Enforces safety and health standards through workplace inspections by compliance officers

• Monitors job-related injuries and illnesses through required record-keeping

• Provides assistance, training, and other support programs to help employers and workers

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What are employers’ responsibilities under OSHA?

• Provide employment and a workplace that is:

1. Free from recognized hazards that are causing or are likely to cause death or serious physical harm to employees.

2. In compliance with established OSHA standards.

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Are there specific OSHA standards that apply to my

workplace?• Recordkeeping• Housekeeping• Medical & First Aid• Walking/Work

Surfaces• Emergency Action• Noise• Hazardous materials

– Compressed gases– Flammable liquids

• Personal protective equipment

• Confined spaces• Lockout/tagout• Fire protection• Powered industrial

trucks• Cranes• Machine guarding• Electrical• Respiratory

protection• Exposure to toxic

substances• Hazard

communicationThere may also be others that apply to your workplace!

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Does OSHA have a specific beryllium standard?

• Federal OSHA – Less than 2 µg/m3 as an 8-hour average– Can be between 5 µg/m3 and 25 µg/m3 for up

to 30 minutes in an 8-hour shift– Must never exceed 25 µg/m3

– Compliance with these levels may not prevent chronic beryllium disease

• CalOSHA – Less than 0.2 µg/m3 as an 8-hour average– Must never exceed 25 µg/m3

• Federal OSHA is currently working to revise the standard for beryllium exposure

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What are employees’ rights under OSHA?

1. Get training from your employer as required by OSHA standards

2. Request information from your employer about OSHA standards, worker injuries/illnesses, and job hazards

3. Request action from your employer to correct hazards or violations of OSHA standards

4. File a complaint with OSHA if you believe there are violations of OSHA standards or serious hazards

• Must be submitted in writing, signed by a current employee or employee representative, and state the reason for the inspection request

• Forms and more information available at www.osha.gov

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What are employees’ rights under OSHA?

5. Be involved in OSHA’s inspection of your workplace

6. Find out results of an OSHA inspection7. Get involved in meetings or file a formal

appeal concerning your employer’s timely abatement of OSHA citations

8. File a discrimination complaint9. Request a research investigation by the

National Institute for Occupational Safety and Health (NIOSH)

10.Provide comments and testimony to OSHA during rulemaking on new standards

Overview of Beryllium

What is Beryllium?

• Forms– Metal– Ceramic (Beryllia)– Alloys (BeCu, AlBeMet)– Contaminant in bauxite, alumina,

recycled metals

• Properties– 3X lighter than aluminum– 6X stiffer than steel– Conducts heat well– Dimensionally stable– Transparent to X-Rays– Reflects neutrons

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All Photos © 2011 periodictable.comUsed with written permission for

non-commerical use

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Beryllium Uses• Airplane and Space

Industries• Nuclear Reactors• Computers, Phones• Automobile Industry• Dental alloys• Contaminant in aluminum

smelting and metal recycling

• Estimated 2010 consumption – 620 metric tons

Photo by NASA available under public domain from Wikimedia Commons

Beryllium in Aluminum Smelters

• Beryllium is found at trace levels in bauxite

• Beryllium concentrates in Alumina during refining process (1-6 ppm)

• Beryllium further concentrates in pot bath during smelting process (200 ppm)

• Beryllium exposure results from all bath handling activities

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Photo used by National Jewish Health with written permission

Health Effects of Beryllium

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Health Effects of Beryllium

• Lungs– Acute beryllium

disease– Lung cancer– Beryllium

sensitization (BeS)– Chronic beryllium

disease (CBD)• Skin

– Several skin effects– BeS

Skin

Breathing

Routes of Exposure

Health Effects

Illustration by National Jewish Health

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Skin Effects• Slow wound healing• Nodules

– Response to beryllium under the skin

• Allergic rash – Beryllium salts

• BeS– Broken skin & cuts – Rash– Even unbroken skin may

not be a complete barrier

Photo by National Jewish Health

All broken skin and cuts should be coveredCovering the skin may reduce the risk of BeS

Nodules

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Lung Effects: Acute Beryllium Disease

• First recognized disease from beryllium• Severe lung disease soon after

exposure– Similar to pneumonia– 5-10% died– Most of the others recovered in < 1 year

• Many later developed CBD

• Due to very high level exposures – 50-1,000 µg/m3 – very uncommon in recent years – possible after extremely high release

• Elevated risk of lung cancer

Photo by BArchBotavailable under public domain from Wikimedia Commons

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Lung Effects: BeS & CBD• BeS (Beryllium Sensitization)

– An allergy to beryllium – BeS causes no symptoms– 2 abnormal beryllium tests (BeLPTs)– Workers with BeS can develop CBD

• CBD (Chronic Beryllium Disease)– Inflammation – Possibly scarring in the lungs

• Most exposed workers will not get BeS or CBD

• Low levels of exposure decrease but do not eliminate the risk of BeS and CBD

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Are YOU at Risk for BeS & CBD?

+

→

→Your Genes

BerylliumExposure

• Less than 1% to 16% of workers tested have BeS• The number depends on level of exposure and industry

• Less than 1% in the primary aluminum industry

• Some workers with BeS had very low exposure

• Some workers who are not sensitized on the first test later become BeS

• 10% to 100% of workers with BeS develop CBD

No immune response

Immune response



Illustration by US DOE available under public domain from Wikimedia Commons

Beryllium Sensitized

Exposed, Non-sensitized

CBD

Be

Be

BeBe

Be

BeBe

Be

Be

Be

Be

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Beryllium SensitizationNormal Response

Abnormal Response

=+Immune cell

=+Immune cell

No Response

Immune cells multiply

Beryllium Sensitization



Be

Be

BeBe

Be

BeBe

Be

Be

Be

Be

Be

Be

BeBe

Be

BeBe

Be

Be

Be

Be

Determined by exposure and your genes

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Normal CBDCBD

NormalCBD

Oxygen easily passes into blood Limited oxygen passes into blood

Oxygen

Oxygen


Illustration by National Jewish Health Illustration by National Jewish Health


→

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Symptoms of Chronic Beryllium Disease

• No symptoms initially• Gradually worsening

– Cough, usually dry– Shortness of breath

• First noticed with physical activity

– Sweating at night– Feeling tired all the time

• In some cases, severe shortness of breath

• Can be mistaken for other lung diseases– May be misdiagnosed if BeLPT not done

• If you have these symptoms, tell your doctor that you are exposed to beryllium


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Treatment of CBD

• THERE IS NO CURE• No symptoms

– No treatment

• Mild symptoms– Inhaled medication

• Increasing symptoms/worsening lung tests– Steroid pills (ex. Prednisone)

• Worsening disease and lung function– Other medications

• Severe disease– Use of oxygen



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How do we test for BeS and CBD?

•Check to see if immune cells multiply (proliferate) when exposed to beryllium •Abnormal response seen in both BeS and CBD•Test does not mean high exposure to beryllium

•A medical evaluation is needed to know if you have CBD

Beryllium Lymphocyte Proliferation Test (BeLPT)

Photo by National Jewish Health Illustration by National Jewish HealthPhoto by US Navy available under public domain from Wikimedia Commons

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Blood cells

Normal

Blood cells multiply

Abnormal

BeLPT: Blood Test for BeS and CBD

Blood cells



Be

Be

BeBe

Be

BeBe

Be

Be

Be

Be

Be

Be

BeBe

Be

BeBe

Be

Be

Be

Be

BeLPT Results• Normal (Negative)

• Abnormal (Positive)

• Borderline – Not normal and not

abnormal – Test needs to be

repeated– Repeat test usually

normal

• Uninterpretable– Test did not work– Test needs to be

repeated

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Be

Be

*

*

Be

Be

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BeS = 2 Abnormal BeLPTs• BeLPT is not a perfect test

– A single abnormal needs to be confirmed (repeated)

– Only commercially available test for BeS (currently)

• Medical evaluation for CBD after 2 abnormal BeLPTs (confirmed sensitization) is standard medical practice

• Also recommend medical evaluation for CBD: – 3 borderline BeLPTs – 1 abnormal + 1 or more borderline BeLPTs

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Medical Evaluation• History and examination• Pulmonary function tests

– Breathing tests

• Exercise tolerance test– Includes tests for oxygen

• CT (CAT) scan/chest x-ray• Bronchoscopy

– Collect immune cells from the lung • Examine type of immune cells present• Perform BeLPT

– Biopsy of lung tissue• Granulomas: Abnormal collections of cells



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When can you get BeS and CBD?

• Within 3 months• After many years• Many years after last exposure

– Beryllium stays in the lungs

• Even after a normal BeLPT• Any time after first exposure to

beryllium

BerylliumExposure Recognition &

Control

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How can I be exposed to beryllium at work?

• Particles produced by work processes

• Particles blown from:– Work surfaces– Clothing– Floor

• Particles from nearby work processes

• Skin contact with:– Bath contaminated

surfaces


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How do I know if I could be exposed?

• If beryllium is in your workplace you might be exposed

• Workers likely exposed:– Production workers– Bath handlers– Maintenance workers– Cleaning personnel– Shipping & Receiving

• Others that might be exposed:– Front office workers– Security guards– Family members of workers

Foundphotoslj, Wikimedia Commons – CC-by-2.0

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How is beryllium measured?• Air samples

– Measure the amount of beryllium in air

– Estimate the amount a worker might inhale into their lungs

– Different types of air samples:

• Personal samples• Area samples

• Surface or Wipe Samples – Measure the amount of

beryllium on a surface– No consistent relationship to

airborne beryllium exposure



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How is beryllium exposure measured?

• Personal samples measure exposure– Workers wear sampling pump for entire

work shift– Best estimate of worker exposure– Meets OSHA requirements

• Area samples: Sampler placed in work area– Measure air levels in non-beryllium areas– Check control measures– Area samples DO NOT measure worker

exposure

Photos by National Jewish Health

Worker “wears” sampling pump

Filter in “breathing zone”

Beryllium collected on filter and tested by laboratory

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What do airborne beryllium levels mean?

• Normal outside air– Average 0.00003 µg/m3

• Lowest level that can be measured– Approximately 0.015 µg/m3

– Cannot measure ZERO• Current Federal OSHA standard:

– 2.0 µg/m3 (8 hour avg) (may not prevent CBD)

• CalOSHA and U.S. DOE standards– 0.2 µg/m3 (8 hour avg)

• ACGIH Threshold Limit Value– 0.05 µg/m3 (8 hour avg)

• Reduce levels for longer work shifts (best practice)– At least 25% lower for 12 hours– At least 50% lower for 16 hours

• There is no level that assures zero risk of BeS or CBD

1 grain of salt = 100 µg

0.2 µg/m3 = 4 grains of salt in air filling the size of an Olympic pool.


What are beryllium exposures like in aluminum smelters?

• Norway (Thomassen et al., 2005, 2008)

– Prebake• Average: 0.11 µg/m3

• Maximum: 0.27 µg/m3

– Soderberg• Average: 0.02 µg/m3

• Maximum: 0.08 µg/m3

• U.S. Prebake (Taiwo et al., 2008)

– Average: 0.04 µg/m3

– Maximum: 12 µg/m3

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Does chemical form of beryllium matter?

• No known differences in CBD risk– Pure beryllium metal– Beryllium alloys

• Beryllium copper, AlBeMet

– Beryllium composites (E-materials)

• Possibly lower CBD risk– Beryllium silicates

• Beryllium in soil and rocks

– Soluble beryllium (salts)• Beryllium fluorides and sulfates

• Possibly higher CBD risk– Beryllium ceramic– Beryllium oxide

• Aluminum smelter workers are exposed to soluble beryllium (20-80%) and beryllium oxide



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Is particle size important?• Particle size effects where beryllium

settles in the lung• Most industrial processes produce

many particles less than 1 µm (invisible to unaided eye)

• Processes with smaller particles have higher rates of CBD/BeS

• In aluminum smelters, about 20% of total airborne beryllium is “respirable” – Large number of particles less than 4 µm

• Small particles can spread throughout the building– Settling time (still air – 2 m)

• 100 µm – 8 seconds• 10 µm – 10 minutes• 1 µm – 15 days

Figure by National Jewish Health

Sizes not actual, Relative size comparison

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Is skin exposure important?

• Beryllium can enter damaged or cut skin• Beryllium dissolves in sweat and may get through skin• Very small particles may get through skin with force or

pressure

Cover the skin to reduce the risk of beryllium sensitization (BeS)

Assembly/Deburr 270 µgMachinists 220 µg Maintenance 74 µgAdministration 0.44 µg

After hand washingUp to 220 µg


Beryllium Hand Wipe Samples

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Is “take-home” exposure important?

• Airborne beryllium has been measured while washing work clothes at home

• Cases of BeS and CBD have been seen in family members of beryllium workersChanging clothes, changing shoes and

showering is important to prevent take-home exposure.

Steering Wheel:

Up to 5.3 µg/100 cm2

Driver’s floor:

Up to 76.8 µg/100 cm2

Driver’s seat:

Up to 15.9 µg/100 cm2

Driver’s armrest:

Up to 39.7 µg/100 cm2


Beryllium in wipe samples from workers’ personal vehicles

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How are beryllium exposures controlled in the workplace?

• Combined efforts needed to prevent and control beryllium exposure– Engineering controls– Work practice controls– Administrative controls– Personal protective

equipment (PPE)– Medical surveillance


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What are engineering controls?

• Ventilation– Local Exhaust

Ventilation (suction)• Enclosures• Facility design

– Hard cleanable surfaces

– Isolation of beryllium processes

– Separate ventilation systems


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What are work practice controls?

• Proper use of engineering controls (all the time)

• Labeling of all beryllium-containing materials

• Use of HEPA vacuums for cleaning

• No compressed air for cleaning• Wet wiping and mopping only• Elimination or isolation of dust

generating activities• No eating or drinking in

beryllium contaminated areas• Education is critical for success

Photos used by National Jewish Health with written permission

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What are administrative controls?

• Restrict entry to beryllium areas

• Limit number of exposed workers• Make sure contractors

understand work practice controls

• Limit spread of beryllium• Work uniforms• Designated work shoes• Designated change areas• Clean break areaKerry Vaughn, Wikimedia Commons – CC-BY-2.0

Changing clothes, changing shoes and showering is important to prevent take-home exposure.

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What is personal protective equipment?

• Skin protection– Long sleeve work uniforms of

tightly woven material– Gloves required when skin contact

with beryllium possible

• Respirators– Recommended (required in

California) for exposures that cannot be controlled to at least 0.2 µg/m3 with engineering controls or to keep exposures as low as possible

• Must be used correctly (no facial hair)

• Must be used when required• Must be medically cleared and fit-

tested• Proper training is necessary

• PPE is only effective when used properly


What is medical surveillance?• Medical testing for health

effects from a hazardous substance– Earlier diagnosis and treatment of

disease• Counseling to minimize exposure

– Can identify places of higher risk exposure

• Places where exposure controls may need to be improved

• Beryllium medical surveillance– Routine testing with the BeLPT

• One time testing is not enough!

Photo by US Navy available under public domain from Wikimedia Commons

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Why do medical surveillance?

• To determine if exposure controls are working• “Safety net” for exposure control

• If no BeS is identified in your workplace• Helps confirm that your exposure controls are working

• If BeS is identified in your workplace• Suggests your exposure controls need to be improved• That other workers in similar jobs may be at risk

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What is included in a beryllium exposure control program?

• Management leadership• Clear employee expectations and training• Methods to prevent spread of beryllium

contamination• Effective exposure controls

– Establish exposure target level– Engineering controls– Work Practice Controls– Proper Use of Personal Protective Equipment

• Frequent measurement of worker exposure• Routine medical surveillance• Written plan• Record keeping

What is the risk of BeS and CBD

at an aluminum smelter?• Two studies (both with limitations)– Norway: 1/362 (0.28%) with BeS (Nilsen et al. 2010)

– U.S.: 9/1,932 (0.47%) with BeS (Taiwo et al. 2010)

• 2 with probable CBD (Taiwo et al. 2008)

• Higher risk from casting of Be-containing alloys• Lower risk than other industries with similar

exposures– Respirators implemented early for other exposures– Less skin exposure due to heat– Likely larger particle size– More soluble forms of beryllium

• 1/200 is a significant risk and justifies exposure control and medical surveillance!

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Questions?


This material was produced under grant number SH-20996-SHO from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U. S. Government.

Documents

Preventing Chronic Beryllium Disease through Exposure Recognition and Control Training for Beryllium Exposed Workers in Aluminum Smelters Training Developed