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

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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

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Offerings

Money

Qualifications Conferences

Membership Publications

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Membership

Membership

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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

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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

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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

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• 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

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Job done then?

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• 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).

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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

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Occupational Health

Preventing work-related

illness

Checking people are fit to work

Promotion of good health

OCCUPATIONAL HYGIENE

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Occupational Hygiene

• Anticipate

• Recognise

• Evaluate

• Control

• Manage

The unique scientific discipline that protects people against health risks from exposures in the work place

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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

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Enigma of Exposure Control A wealth of experience, knowledge and engineered solutions, but…

OCCUPATIONAL CANCER

NOISE

DUST

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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

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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

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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 .

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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

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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

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One of several problems: Employers sold inappropriate and expensive LEV systems that don’t work

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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!

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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

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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

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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

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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

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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

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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".

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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

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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”

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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)

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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.

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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

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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.

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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…

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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

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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

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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

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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

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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!

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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

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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

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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

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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!

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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/

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Strategy

Vision & Strategy

British Occupational Hygiene Society