While educational programmes focusing on the risks of workplace respiratory hazards have increased in recent years (British Occupational Hygiene Society’s (BOHS) ‘Breathe Freely’ campaign1 and the Institution of Occupational Safety and Health’s (IOSH) ‘No Time to Lose’ initiative2), there is still much more that can be done.
This is emphasised by statistics from the Health and Safety Executive (HSE) who estimate each year that there are some 12,000 deaths in Great Britain from lung diseases linked to exposure to hazardous substances at work3. In addition, a further 18,000 new cases of lung or breathing problems caused (or made worse by) airborne hazards in work environments will be reported over the same time period3.
When considering these numbers, one must account for the fact that symptoms of occupational lung diseases can take several decades to present themselves, but even so, they show no signs of decreasing. The HSE says that the rate of self-reported, work-related lung or breathing problems has remained mostly consistent over the past ten years, with an estimated 130 cases per 100,000 workers3.
Reducing these figures still requires significant efforts on the part of employers and employees themselves.
Seeing the Hazard
Harmful airborne hazards are numerous, and many are well known. Crystalline silica, for example, is a natural substance found in stone, bricks, concrete, rocks, gravel, clay and sand, and becomes airborne as a result of cutting, grinding and drilling these materials. The inhalation of Respirable Crystalline Silica (RCS) can cause a lung disease known as Silicosis, which is characterised by inflammation and scarring of the lungs.
Our understanding of hazards such as RCS is evolving constantly, and new research often reveals that standards and workplace exposure limits (WELs) previously deemed acceptable are, in fact, not conducive to good health. In February 2019, for instance, the HSE issued a safety bulletin about the change in enforcement expectations for the control of welding fumes, determining all weld fumes to be carcinogenic4. This decision has had a significant impact on a wide variety of industries and, from my experience, has driven improved knowledge of workplace respiratory hazards within welding related industries – a welcome benefit.
Companies have a legal duty to limit the exposure of their employees to these hazards. Under the Health and Safety at Work etc. Act 1974 and the Management of Health and Safety at Work Regulations 1999, they are required to provide and maintain a safe working environment, so far as is reasonably practicable. Typically a ‘Hierarchy of Controls’ is considered when limiting exposure: Elimination, Substitution, Engineering, Administration and finally Personal Protective Equipment (PPE).
“RPE should always be considered the last line of defence once other control measures are implemented”
PPE (including Respiratory Protective Equipment, or RPE) should always be considered the last line of defence once the other control measures are considered and/or implemented. However, according to the HSE, an in-depth investigation of a small sample of companies “showed only around half were effective in protecting the wearer through their use of RPE as a control”, owing to a lack of understanding, knowledge and awareness5. So, what are the common steps in providing effective respiratory protection?
Assessing the Risks
In the first instance, companies must carry out risk assessments, firstly to identify any airborne hazards. Steps should then be taken to limit and reduce individuals’ exposure to airborne hazards. This is where consideration of the Hierarchy of Controls comes in. However, respiratory hazards will sometimes remain even after such measures have been taken. In these cases, employees may still require adequate RPE, which can reduce exposure to the hazards faced, to the level required to protect the wearer’s health.
To find adequate RPE, employers should first narrow down their options to include only those that can protect against the hazards identified in the initial risk assessment. Next, employers should whittle down their options further, to include only RPE that is also capable of protecting against the concentration of the hazard present in their workplace. Typically, RPE manufacturers can assist with this process by providing an overview of their products’ capabilities.
Suitable RPE and Wearer Diversity
Not only should RPE be adequate, it should also be suitable for its intended use. Comfort is one of the main factors affecting rates of compliance. It is therefore important that during selection, individuals look for RPE incorporating features that maximise comfort such as soft materials in contact with the skin and easy opening exhalation valves that can efficiently vent hot and humid air exhaled by wearers.
Because all people are different and comfort is subjective, it is important that – once the RPE options have been narrowed down to those that can provide adequate protection – workers are involved in the final RPE selection process. Experience has indicated that if workers become involved in the selection decision and trial product options, they are more likely to comply with wearing RPE when it is required.
Common types of RPE for consideration may include filtering facepiece disposable respirators, reusable respirators and powered/supplied air systems. These options provide a variety of different features to suit the needs of the user and their working environment. In addition, manufacturers often design a range of products with the same levels of protection in a variety of shapes and sizes to accommodate a broad spectrum of facial features.
A Hairy Situation
Trends must also be considered. For instance, facial hair remains popular for many men – a fashion that doesn’t look like it will be dissipating any time soon. According to research by YouGov in 2017, 42 per cent of men now have some form of facial hair, of which 44 per cent sport a full beard6. But its presence can have a significant detrimental effect on the performance of RPE. In 2015, HSE carried out tests7 on 15 volunteers with varying amounts of facial hair using a range of facepieces with different types of face seals.
The results of these tests indicated that, with the selected tight fitting filtering facepieces and half masks, the protection given to the wearer was reduced if they had stubble. The effect of stubble may begin within just eight hours of the subject shaving, and increases as facial hair grows7.
It is important that workers are taught how to use and correctly fit their masks, and on the importance of being clean-shaven if wearing a tight-fitting respirator. This is where face-fit testing by a competent person can play a vital role.
Competent fit testers not only have a valuable role in confirming fit of RPE they can also provide one-to-one training for wearers to reinforce the message of the importance of correct fit (including donning instructions), compatibility with other PPE (other head worn PPE should be worn during the fit test) and talk about the negative effects of facial hair on fit. The number of Fit2Fit8 accredited fit testers (supported by the HSE) is growing.
There are, however, some RPE options for those who do sport various degrees of facial hair. Typically, these are known as loose fitting headtops which are afforded either filtered powered air through a battery powered turbo or a regulator providing breathable quality air from a secondary air source. These loose fitting devices allow for the whole head and face to be covered, with the seal made either under the chin, around the neck or via an inner shroud. These loose-fitting devices do not need to be face fit tested either.
The Importance of Fit
When specifying Respiratory Protective Equipment (RPE) which includes Respiratory Protective Devices (RPD)
it is important to consider the role of Fit2Fit and the needs of the user in addition to the performance characteristics of the RPE.
The importance of protecting workers from hazardous dust and fumes is not a new topic of debate. For some 2,000 years, the potential dangers have been recognised.
Fast forward to the present day and the issue remains a hot topic for debate and a key area of international safety legislation. So much so that 2018 saw the introduction of the ISO 16975-3:2017 – a new standard specifically designed to provide guidance on how to conduct a fit testing of tight-fitting Respiratory Protective Devices (RPS)
Designed to evaluate the effectiveness of the seal between the wearer’s face and the respiratory interface, specific requirements for conducting RPD fit testing outlined in the new standard include:
• Qualifications/competencies of fit test operators
• Specific fit testing procedures
• Interpretation of fit test results
• Record Keeping
We need to drive mindsets away from pure respirator performance to the relationship between respirator and each individual user. In the past a lot of disposable respirators were introduced to the market to purely meet the EN 149:2001+A1:2009 standard, without necessarily considering the individuality of the user, how it fitted them and how it was used.
The assumption goes, that if someone fits a particular disposable FFP3 mask that would then apply to any FFP3 mask product – WRONG! It is important to reinforce the message that if a respirator model is changed then the wearer needs to undergo a new fit test.
Where a tight-fitting face mask is required, a fit test on that mask and the person wearing it needs to be carried out. This is a legal requirement detailed in the CoSHH regulations.
Some people still don’t understand whether fit testing is a requirement for them or don’t know enough about it
to make an effective judgement. Fit testing is also seen by some as time consuming, expensive or not applicable to them e.g. ‘I only wear a mask once a week, so its over the top and it’s not needed’.
Regardless of how often a mask is used, if its being used as an item of PPE it needs proper fit testing. It’s also recommended that regular fit testing is undertaken, ideally at least once every two years.
Finding the Right Fit-Tester
Recent research indicates that up to 50 per cent of all RPE used does not offer the wearer the level of protection assumed, and one of the major reasons is that it simply does not fit! Yet, under the regulations RPE must be correctly selected and this includes, for many types of RPE, a face piece Fit Test conducted by a competent person. So how can you be sure the person conducting the fit test is competent?
Despite not being qualified to do so, some people think they are competent enough to fit test. RPE fit testing should be conducted by a competent person, anyone carrying out the fit test must be appropriately trained, qualified and experienced.
In view of these major concerns the British Safety Industry Federation, along with the HSE and other industry stakeholders, have developed a competency scheme for Fit Test Providers. The Fit2Fit RPE Fit Test Providers Accreditation Scheme is designed to confirm the competency of any person performing face piece fit testing.
What makes a Fit2Fit accredited tester competent? They have passed an industry recognised exam and therefore demonstrated they have a thorough knowledge of the HSE guidance on fit testing and can demonstrate they have the know how to fit test in practical circumstances.
If you or your employees require a fit test, then by using a Fit2Fit accredited tester you will be doing enough to demonstrate best practice and making sure the user of RPE is properly protected and has an effective seal on their mask.
Changing Mindsets and the Next Generation
It is also the responsibility of workers (with the assistance of their employers) to take the respiratory hazards they face seriously. In many cases, the consequences of not wearing the correct PPE are obvious. It’s easy to imagine the dangers of being hit on the head by a falling object, so the wearing of a hard hat is simply common sense. Harmful airborne hazards, on the other hand, can be colourless, odourless and tasteless, and can therefore be easier to dismiss.
Since many occupational lung diseases have long latencies, it is very easy for workers to become blasé about the threats, and to adopt the mindset that ‘it won’t happen to me.’ This mindset needs to change – resources from BOHS, IOSH and other industry bodies including the Construction Dust Partnership can provide helpful ideas for communicating the deadly respiratory risks employees encounter.
A programme that is focusing on new industry entrants is the LOcHER Project9. Since inception it has been teaching students and apprentices to identify health and safety risks in their workplaces, learn about how they can protect themselves from these threats and take that experience into the world of work. By engaging with students early on in their career, the project aims to establish good practices that will, ultimately, reduce the risks of them developing occupational lung diseases later in life. While the statistics mentioned at the start of this article have improved from the decades preceding, there is still much more that can be done. When we give workers the right education regarding the dangers of respiratory hazards and back this up with an ever increasing choice and variety of adequate and suitable RPE we can hope to see a steady trend downwards in work-related ill health statistics.