Seminar 2007: Prevent Work-related Dermatitis
Prevent Work-Related Dermatitis
It’s In Your Hands©
18 October 2007
The Netherwood Hotel
Grange-over-Sands
Organised by:
South Cumbria Occupational Health & Safety Group
in association with
South Cumbria IOSH District, Manchester & North West Districts' Branch,
The Health and Safety Executive & Safety Groups UK
Speakers:
HSE and HSL Specialists
Exhibitors:
Ansell, Arco, BMPolyco, DEB, Degussa-Stoko, Globus, IOSH Manchester and NW Districts’ Branch, South Cumbria Occupational Health & Safety Group (SCOHSG).
Handouts:
HSE, EUOSHA, Marigold.
(94 present including 5 HSE/HSL speakers)
Martin Fishwick, Chairman, South Cumbria IOSH District and SCOHSG, welcomed speakers, delegates and exhibitors, and outlined domestic and emergency arrangements.
Introduction to the Health & Safety Executive (HSE) DERM project
Martin then explained that the DERM project was jointly run by HSE, the British Safety Industry Federation (BSIF) and Safety Groups UK (SGUK). It is part of the wider Disease Reduction Programme (DRP), within HSE’s FIT3 project, which aims to:
Fit 1 - Reduce Workplace Injuries
Fit 2 - Reduce Workplace Ill Health
Fit 3 - Reduce Workplace Lost Time
The DRP is currently targeting skin and respiratory disease, and cancer from asbestos and chemicals. There were 29,000 cases of contact dermatitis (3,500 per year), and 15 million workers are exposed to risk. Martin explained that dermatitis affects a wide range of industries (including his own organisation).
HSE is targeting known high risk workplaces for dermatitis. Their programme aims to:
Raise awareness of dermatitis pathways - Directors, managers and staff
Provide advice and support
- training, good controls and good practice.
Enforcement - last resort
Martin then handed over to Dr Bob Rajan OBE, of HSE, who is leading the HSE DERM project.
Bob stressed the importance of Dermal Exposure Risk Management, using simple controls. Claims payments of up to £300,000 have been awarded.
What is contact dermatitis?
Diane Llewellyn, HSE Specialist, then gave an introduction to contact dermatitis. She explained that the skin consists of a tissue paper thin epidermis (dead skin) over a thick dermis, with cells, veins, sweat glands and hair follicles. The skin protects against chemical, physical, biological and mechanical insults and water loss, protecting the body and regulating temperature. Skin is normally elastic, but water loss can cause cracks, and excess, cell damage.
Contact dermatitis (or excema) is inflammation of the skin; it may be one of two types:
1. Irritant dermatitis: inflammation of the skin following cell damage, or
2. Allergic dermatitis:
a. Delayed - in which skin penetration leads to histamine release via the lymph nodes
b. Immediate - in which penetration causes sensitisation to subsequent exposures, with histamine release via IgE antibodies (urticaria).
Many chemicals, solvents, cleaners, foods, rubber and water can cause either or both types of dermatitis.
Diane defined wet work as using water for tasks for more than two hours per day, or hand washing more than 20 times per day. If the skin is unprotected on a regular basis such exposures to water can lead to serious skin damage - cracks, blisters, itching, pain, and ultimately to an inability to feed or dress ones-self, job loss, and/or social isolation.
Dermatitis has also resulted in 31,000 days lost to industry per year with an estimated cost of £44 million per year. Diane gave examples of HSE notices served, prosecutions and civil claims across a range of workplaces such as: workers changing chemicals used in photo booths, mechanics, welders, industrial process workers, cleans, caters, and hairdressers etc... Finally, Diane mentioned the risk of systemic diseases.
Managing Work Related Dermatitis – part 1
Bob Rajan then discussed Managing Work Related Dermatitis. He first described the skin project which aims to reduce cases of dermatitis by 10% by 2008, and to reduce lost time from contact dermatitis. He described the HSE's work as:
Communication & Awareness
leading to
Interventions, Controls & Culture change
He emphasised that:
Hands are an aid, not a tool.
Gloves are not necessarily an appropriate solution and
Persistent wet and dry cycling of the hands is a common cause of dermatitis.
Bob explained that it was necessary to identify potential workplace triggers for dermatitis:
Chemicals/substances in use - consider substitution
Means of exposure - handling procedures, ventilation, containment, PPE
Existing controls - fit for purpose?
He reminded delegates that it is important to monitor the effectiveness of controls, even after improvement; staff may become complacent or find the revised Safe System of Work inconvenient or incompatible with workplace targets.
He highlighted the relevant legislation, especially Control of Substances Hazardous to Health Regulations (COSHH; requires good controls and good practice) and RIDDOR (requires lost work day reports - under reporting was rife).
He then outlined the necessary Controls Hierarchy that should be agreed after consultation with those undertaking the tasks:
Task and equipment - appropriate, practical design of equipment and task
Correct operation - equipment, protocols, systems of work, training
Equipment - suitable for task, regular maintenance checks, staff trained in use
Ventilation - with extraction if appropriate, regular maintenance, staff training
Organisation - clear responsibilities, training and information and
PPE - last resort; appropriate for task, properly maintained; appropriate training and information for users.
COSHH requires Risk Assessment and a Safe System of Work before work starts. This should include handling, storage, transport, use, and waste disposal of all potentially harmful substances. The aim is minimum contact with substances and maximum protection for all staff and visitors who come into contact with potentially hazardous substances.
Good practice requires consideration of the following:
1. Exposure to substances should be:
a. Less than the Workplace Exposure Limit (WEL) for most COSHH substances, &
b. As Low As Reasonably Practicable (ALARP) for carcinogens and sensitisers.
2. Appropriate ventilation
3. Good hygiene
4. Information, Instruction and Training
5. Contingency plans.
6. Ventilation - as well as reducing inhalation exposure it reduces ingestion, skin exposure, and deposition (leading to contaminated workplace surfaces).
Managing Work Related Dermatitis – part 2
In the second part of his talk Bob talked about potential pathways to dermatitis including:
Immersion - dipping pottery in glaze by hand, washing equipment etc…
Touching - equipment, surfaces, items being worked on etc…
Surface contamination - from dust or splashes
Splashing - from hoses, dispensers etc…
Deposition - on surfaces, equipment, protective clothing etc…
Handling - using hands rather than a simple tool, or redesigning the task
A Tyndal lamp is useful for showing airborne dust/mist that is invisible to the eye under normal light conditions.
Overalls washed at home can also be a possible source of contact dermatitis.
Solvents should not be kept/used/carried in open containers (an additional exposure hazard may be neurological or mental health problems).
The mnemonic is APC:
Avoid
Protect
Check
Avoid
- maintain a safe working distance by using tools and equipment (not hands)
- mechanise task if practicable
Protect
- use skin protection (apply to clean hands
- teach correct glove on/off procedures
- select gloves/PPE for the substance, task, environment, and wearer. CE accreditation for PPE is not a universally agreed standard identically applied by all manufacturers
- wash and dry hands with gentle media (not soap), and use a post work moisturiser (unperfumed?)
- use extraction equipment if appropriate
Check
- regular monitoring of potential dermatitis exposure routes:
a. Airborne - a Tyndal lamp is a useful indicator
b. Surface contamination (eg ventilation hoods, work surfaces) – wipes sent for analysis. Results of tests should be recorded and preventative action taken if necessary eg revise Safe System of Work.
- a Responsible Person should regularly check for early signs of dermatitis such as workers with dry/itchy/red skin and
observe work practices.
Good and bad ventilation controls
Martin Roff, Health & Safety Laboratory (HSL), then gave us a talk and demonstration on good and bad protection of hands. He reminded delegates of the control hierarchy for dealing with potentially hazardous substances in the workplace:
Eliminate
Substitute
Enclose
Mechanical controls
PPE & RPE – must include training in use and maintenance.
Don't be a fool, use a tool! When practicable, tools should be used to create distance between workpiece, container, or chemical and the worker.
Avoid reaching up if using liquids.
Gloves must be selected for correct material and thickness.
Martin then demonstrated glove degradation using acetone and a colour change patch inside the glove. He followed this with demonstrations using volunteers donning and doffing gloves externally contaminated with a bacteria simulant detectable with a UV lamp. He emphasised the difference in the way that single use and multi-use gloves should be removed.
Single use gloves:
- reverse on removal and dispose of immediately
Multi use gloves:
- check for pin-holes before use (blow up gently like a balloon)
- wash gloved hands before removal
- store carefully to avoid contamination - do not use other peoples' gloves
- handle discarded gloves with care
He noted that inner cotton gloves or liners can help absorb sweat, which is acidic. Martin re-iterated that care is needed in selection and use of pre work cream; it can help, but can rub off, or retain contamination. However, that and moisturiser can help retain good skin condition.
Working Together to Prevent Work Related Dermatitis
In his next session Bob showed us a CD in preparation, entitled "Working Together to Prevent Work Related Dermatitis" part of the HSE "It's in Your Hands" campaign.
The CD starts with examples of bad cases of dermatitis such as cement burns that the worker does not feel immediately. It describes all the possible consequences of exposure, and then goes through all the precautions we had been told about during the seminar. These include looking at SDSs and substance Risk phrases, avoiding contact with chemicals, workpieces, surfaces, and appropriate use of PPE etc…
The CD also covers the need to avoid uncontrolled spread of substances, safe work distances, ventilation, skin protection, regular changing and cleaning of PPE, use of HSE information, risk assessments, training, regular checks by a trained responsible person, gentle hand washing/drying, investigation and action on problems.
The CD includes a video on "Skin at Work". All attendees should receive a personal copy of the CD from the HSE as soon as it is available.
Bob also mentioned that latex allergies from gloves can be exacerbated by use of powder in the gloves. He reminded delegates that alternatives exist.
Dermatitis case studies
Diane's second session, after lunch, consisted of printouts of case studies that were considered by small delegate groups, and then discussed by all delegates. The aim was to seek simple (often inexpensive) solutions; in some cases, rejecting unsound opinions included in the scenario.
The case studies considered were:
1. Rosin moulding
2. Hairdressing
3. Metalwork, welding and use of lathes
4. Catering and
5. Printing.
Observations included general surface contamination, multiple chemical exposures, splashing of operator and others, need for proper glove selection, open work with solvents and no tools and the need for better design of extraction systems. Hopefully we learned, at least we didn't nod off!
Local Exhaust Ventilation (LEV)
The final speaker was Dominic Pocock, HSL, who gave a talk and demonstration on LEV. He outlined the results of air movement experiments that demonstrated how contaminants spread, and reiterated the diagnostic benefits of Tyndal lamps.
He explained that the current HSE LEV Guide is being revised, and then went on to describe the component parts of an LEV system: Hood/enclosure,
Ductwork
Filter/cleaner
Fan (axial or centrifugal), and
Stack
Dominic then focused on the collector options, describing and demonstrating their effectiveness with a working LEV model and smoke generator. He showed that a captor with just an open duct end only gives 10% of LEV duct velocity one diameter away. The LEV flow velocity must be enough to capture particles with zero velocity; this can be helped by adding a flange, or by adding a partial enclosure, which must be large enough to capture contaminant. The air flow must be undisturbed with non turbulent flow eg lab fume cupboard. Downdraw, with negative pressure within gives the most efficient result.
It has been found that eddy currents in paint spray booths can persist for up to 10 minutes after spraying has finished therefore Respiratory Protection Equipment (RPE), must not be removed too soon. Each of these scenarios was illustrated by videos and/or smoke demonstrations.
Enclosures (including those used for biohazards), must be large enough for the task, with adequate flow rate, and the extraction system designed for the process including containment of the operator if necessary. Extraction air flow characteristics change when objects and people are in the vicinity; such factors must be taken into account when designing or modifying extraction systems.
An extraction receptor is a part enclosure with low air flow rate where the contaminant is sucked into the hood. It must be close to the work and moved as necessary, or it can be attached to the tool if the receptor and extraction system does not interfere with the use of the tool (due to size or weight). Again, the effectiveness of these options was illustrated.
Dominic also reminded delegates that it was necessary to face the Tyndal lamp when assessing the air currents generated during particular tasks. He suggested using smoke tubes, or bombs, or fog machines, to assist with visualising air flow characteristics.
Implementing Responsible Health Risk Management
In his closing remarks, about implementing Responsible Health Risk Management, Bob introduced us to AIDAR
Awareness
Interest
Desire
Action
Review and
Reward
Dr Bob Rajan OBE, HSE Specialist, then thanked delegates, exhibitors and the committee for a good turnout at the seminar and expressed the hope that delegates would return to their workplaces able to help prevent dermatitis in the workplace having learnt it’s as easy as APC – Avoid, Protect and Control as part of the HSE "It's in Your Hands" campaign
Martin Fishwick, Chairman, South Cumbria IOSH District and SCOHSG, then thanked Bob and his HSE/HSL team, the exhibitors, the committee organisers, and the delegates for supporting our seminar. After a draw, an IOSH textbook was given to the winning delegate.
Delegates then adjourned for refreshment, or to revisit the exhibits before their journey home. |
