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Respiratory Disease [November 2011]

Published: 10th Nov 2011

Jill Joyce, senior policy and technical advisor at the Institution of Occupational Safety and Health (IOSH), discusses using respiratory protective equipment (RPE) in the workplace and the practical steps that can be taken to reduce respiratory disease.

Respiratory disease is no stranger to the Middle East. According to the World Health Organization (WHO)1 there were 407,000 deaths from respiratory infection in 2008, including 160,000 associated with chronic obstructive pulmonary disorder (COPD) and asthma, and 25,000 attributed to cancers.

Some of these respiratory problems are affected by environmental factors; for example, in the desert area of the Middle East there are extreme temperature changes which can worsen chronic lung diseases like asthma. Some respiratory problems are due to more local, poor lifestyle choices, such as water pipe smoking.

The workplace, however, is one area where practical steps can be taken to fight respiratory disease and reduce the human suffering and cost both to companies and to society.

Respiratory disease is a long latency disease. This means that it may take a long time to appear after exposure to the contaminants in the workplace which cause it.

Airborne contaminants can include solids (dust, powder and fibres), gases and vapours (usually resulting from a chemical process), mists and aerosols (finely dispersed liquids) and fumes. Some contaminants can trigger an allergic reaction in the respiratory system. Asbestos fibres cause illness by becoming embedded in the lungs. The fibres cause scarring of lung tissue, and can reduce the effectiveness of the lungs. In some cases, this can result in cancer.

Respiratory illnesses may be chronic, with long term discomfort. The effects are made worse by repeated and prolonged exposure to contaminants over a working life. Chronic respiratory illnesses include:

• Asthma

• Chronic obstructive pulmonary disease (COPD)

• Pneumoconiosis (coal dust)

• Silicosis (quarry work, foundries or potteries)

• Allergic alveolitis (‘farmer’s lung’)

• Allergic rhinitis (hayfever)

Byssinosis (cotton dust) The main asbestos-related diseases are:

• Asbestosis

• Mesothelioma

• Asbestos-related lung cancer

• Diffuse pleural thickening

Respiratory failure can be acute, where workers die within a short time of being exposed to a respiratory irritant or poison. This can occur when exposures to isocyanates occurs, when paint spraying, for example.

What steps can be taken in the workplace to prevent exposure?

Prevention of both chronic and acute respiratory illnesses starts with the same question: how can contaminants be eliminated or reduced? You need to consider the following five controls as a hierarchy:

• Elimination and substitution

• Isolation and ventilation

• Provision, use and maintenance of respiratory protective equipment (RPE)

• Training and information

• Monitoring and health surveillance

Elimination and substitution

You will need to identify which substances are being used that can result in respiratory illnesses. Safety data sheets should warn you if a substance is a respiratory sensitiser. Be aware that common substances such as sawdust, hay and flour can create problems. Factsheet 39 from the European Agency for

Safety and Health at Work provides useful advice on where natural and chemical sensitisers may be found.

Having identified hazardous substances, can you stop using or producing the substances that cause problems? For example, if sawdust is created as a byproduct of sawing timber, can you simply buy timber already sawn to size? Are there safer alternatives to the substances used? If so, substitute the safer substance for the more hazardous one. Can you use less of the substance?

Isolation and ventilation

If a significant risk remains, consider how the substance can be isolated. Enclosing a process which produces a respiratory sensitiser is a more effective safeguard than expecting every person who walks through an area to wear respiratory protection. Contaminants from the enclosed area must be safely ventilated and dealt with; for example with a filter to catch solid particles.

Where the work area cannot be completely enclosed, can you reduce the number of people exposed and the amount of time they’re exposed for? Where some workers are still exposed, ventilation needs to be provided. Enclosures and ventilation systems must be maintained and checked to make sure they’re working effectively. Care should also be taken in developing cleaning procedures so that cleaners aren’t exposed to respiratory sensitisers more than necessary. Wet cleaning or vacuum cleaners, for example, should be used in preference to sweeping.

Local exhaust ventilation (LEV) systems, sometimes called dust and/or fume extraction systems can help clean the air before workers breathe in the harmful substances. If you decide that you may need a LEV and know which jobs and activities cause exposure, it’s worth getting a reputable supplier to give you advice. Workers can also be involved in the design and selection of the LEV. It’s important to make sure the LEV is installed properly and that it has airflow indicators so that you can see it is working correctly. You need to ensure you get a user manual from your supplier, and there may also be a log book so that you can record repairs. Once a year the LEV needs to be examined in detail and tested by a competent person.

Workers need to be alerted to notice whether the indicator is showing that the LEV is working properly and that they might not be able to see all the harmful dusts or fumes, as they may be invisible. They need to be aware of any unusual noises or vibration and to notice any smells or dust that were not there before. These might indicate it is not working properly and employees need to tell their supervisor if such changes are noticed.

Provision, use and maintenance of RPE

Only when everything has been done to eliminate or reduce the hazard through substitution, isolation and ventilation should RPE be considered. Two main types of RPE exist: respirators (which use filters to remove contaminants from the air before the user breathes it), and breathing apparatus which supplies high quality air to the wearer.

Respirators must never be used in confined spaces, areas of low oxygen levels or very high contaminant levels. Breathing apparatus uses air which is supplied from an air cylinder or compressor and can be used in confined spaces or areas where the oxygen level is low.

Selection of RPE should take account of individual factors, such as:

• Facial hair, glasses or contact lenses, medical conditions such as existing respiratory illnesses, high blood pressure, claustrophobia, heart disease, difficulties with hearing, and skin conditions such as eczema

• Task factors - duration of task, temperature, humidity, work rate (sedentary, moderate or heavy work, which might mean an increased air supply is necessary), tools being used, other personal protective equipment (PPE) needed, requirements to see fine detail, to move around or to communicate, congestion in the work area

• Other hazard factors - Risk phrase (R-phrase) from the safety data sheet, amount of substance used, dustiness (of solids such as pellets, grains or powder) or volatility of liquids. For asbestos it would be the expected concentration of asbestos fibres in the air. It is important to note that particulate filters which might protect against asbestos will not protect against oxygen deficiency, gases or vapours.

Workers may find RPE uncomfortable to wear and be tempted to remove their mask if it gets hot or uncomfortable, or they find it hard to breathe through.

They may alter the position of the straps and make the mask ineffective. This is why ‘face fitting’ is important - every mask should be tested for a good fit. If the worker cannot see the contaminant or cannot smell it, then they are less likely to want to wear a mask. This also highlights the need for training.

It’s important to train workers to look after their RPE, as badly maintained RPE will not provide sufficient protection. It needs to be cleaned and stored correctly after each use. For breathing apparatus it is essential to check the flow rate and air pressure of the air supply at the beginning and end of each shift. Filters need to be changed regularly and valves checked for cracks and wear.

Where processes creating airborne contaminants have been isolated, workers need to know to keep away; for example, not using an area as a short cut where respiratory hazards may be present. Those who need to enter the area should know what RPE is required, how to make pre-use checks, and how to wear it correctly. Everyone should understand the procedure for reporting any respiratory problems which may be work related, whether or not they’ve been identified as working in a hazardous area.

Monitoring and health surveillance is also important. Air quality should be monitored to make sure levels of contaminants in the air stay below an acceptable level. Individuals can wear monitors or workplaces can be monitored directly. A wide range of sampling methods can be used, including:

• Sampling pumps, with appropriate tubes and filters

• Colour tubes

• Passive sampling badges

• Direct reading instruments, for real time readout of results

• Data logging instruments for collecting data over time

• Biological monitoring

There are three approaches that can be used to evaluate workers’ exposure to airborne contaminants. Firstly, environmental monitoring indicates presence or not of airborne contaminants. Secondly, biological monitoring documents absorption of contaminants into the body. Finally, medical surveillance is used to detect adverse health effects (including biological effect monitoring), which may be due to exposure.

To assess the level of airborne contaminants in the workplace atmosphere, air sampling can be used. This can form part of routine surveillance, and can also be used to help to design and evaluate the effectiveness of existing control measures. It helps to measure the dose of a hazardous agent that is absorbed by workers and records of air monitoring can be documented to show compliance with government regulations and standards.

Air sampling involves taking a known volume of air through a sampling medium (normally a filter paper for solids and a sorbent tube or glass impinger for gases) on or in which the contaminant is captured. The sample can then be sent to a laboratory for analysis. The concentration of the contaminant is calculated using the volume of air and the amount of pollutant captured. Standardised air sampling and analytical methods have been developed to ensure accurate and meaningful information is collected.

Health monitoring (medical surveillance) should involve an assessment of a worker’s respiratory health before they start a potentially hazardous job. A suitably qualified health professional can help you decide how often the worker should be reassessed. Records should be kept of all assessments, along with a description of the work undertaken. If health problems are identified through regular checks, or if workers report symptoms between tests, action may be needed to remove the worker from the job until a further assessment is made.

Finally, supervisors and managers play a crucial role in promoting a safety culture where all workers recognise the importance of RPE. If a company that states that safety and health are their first priority has employees that take unsafe short cuts when managers are not around, this indicates that different core cultural values exist. It is up to supervisors and managers to make sure they set a good example by their actions. ?

References

1. http://www.sciencedaily.com/releases/2011/07/110713102026.htm

Author Jill Joyce BA (Hons) MSc, CMIOSH, AFBPsS, DMS

Chartered Safety and Health Practitioner

Jill Joyce is senior policy and technical adviser at the Institution of Occupational Safety and Health (IOSH), based in the UK. IOSH is the chartered body for health and safety professionals. With more than 39,000 members in 85 countries, the institution is the world’s biggest professional health and safety organisation.

IOSH has a Middle East Branch which consists of more than 800 members who actively promote ‘good’ workplace safety within the region. For more information about the Middle East Branch visit http://www.iosh.co.uk/branches/middle_east.aspx

Jill pioneered the safe learner concept for the Learning Skills Council (LSC) and has worked on a number of projects producing learning materials for young people. Since joining IOSH she has worked on WiseUp2Work and the Workplace Hazard Awareness Course (WHAC). She represents IOSH on the Health and Safety Executive’s Respiratory Protective Equipment project and the Asthma Board. Jill writes a number of articles and guidance on topical occupational safety and health issues. Her main interests are workplace wellbeing, respiratory protection, rehabilitation and young people’s attitudes to risk.

Jill has previously worked at the Department of Employment, the Further Education Funding Council and the LSC and has been involved in health and safety for more than 20 years.

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Published: 10th Nov 2011 in Health and Safety Middle East

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