Part 10: Health Hazards on Site

1. Part 10: Health Hazards on Site Construction Health & Safety Management Simon Smith (University of Edinburgh) & Philip Matyear (Balfour Beatty)

2. Overview General Legislation HSE view Other - Weils Disease Summary Further reading / Information What are the main hazards ? 1. Skin - Dermatitis 2. Skin Cancer 3. Respiratory Problems - Occupational Asthma 4. Respiratory Problems - Asbestosis 5. Hand - arm vibration syndrome 6. Noise induced hearing loss 7. Musculo-skeletal injury's

3. General We all take our health for granted, but every day on site we are exposed to numerous health hazards from every day things we use or have become accustomed to within our daily routine. In this presentation we take a brief look at some of the typical hazards on a construction site, what it does to our health and what we can do to help minimise the risks. Our health not only affects our ability to work but can also have a significant impact on our social life.

4. Health Legislation Contrary to popular belief there is a substantial amount of legislation surrounding employee health and health management. • Health and Safety at Work Act etc 1974 • Requires employers and self employed workers to: • Ensure they provide and maintain safe methods in the use , handling, storage and transport of articles and substances. • Employees to take care of their own and others health and safety. • Management of Health and Safety at Work Regs 1999 • Regulation 6. Health Surveillance • Provide appropriate health surveillance with regard to risks identified in risk assessment. • Construction, Design and management Regs 1994 • Applies to all stages of a construction project and places duties upon clients, designers and contractors. The regulations aim to ensure: • Reduction of risk at the planning and design stages - design out health hazards by specifying less hazardous materials. e.g Solvent free adhesives. • Control of Substances Hazardous to Health Regs 2002 • Regulation 11. Health Surveillance • Where employee's are exposed to substances listed in schedule 6 of the Regulations or where it is reasonably foreseeable that a disease or health condition may arise from exposure to a substance, health surveillance shall be provided. Other regulations requiring health surveillance include; The Control of Asbestos at Work Regulations 1987(3rd Edition) The Work in Compressed Air Regulations 1996 Control of lead at Work Regulations 1998 Ionsings Radiation Regulations 1999

5. HSE view Revitalising Health and Safety in Construction Construction has a reputation for being a particularly unhealthy industry to work in because its rate of work-related illness is one of the highest of all occupational groups. Health problems within the industry are prevalent because of the number of high-risk work activities involved and the transient nature of the work force. Health issues have always been on the HSE agenda but in the last three years the management of health on site has come under much closer scrutiny. We can now expect visiting HSE inspectors to ask questions about hand arm vibration management, dermatitis caused by cement and noise control.

6. What are the main health hazards ? Respiratory Problems Asthma Asbestosis Noise Induced Hearing Loss Vibration White Finger Skin Dermatitis Cancer Musculoskeletal Injuries

7. Health • 1. Skin - Dermatitis • Few people realise what a serious and debilitating disease dermatitis can be until it happens to them. It is one of the most widespread causes of ill health affecting many people in different industry sectors. • It is caused by the skin coming into contact with certain substances. • Symptoms of the condition can be; • Redness, • Itching • Scaling and blistering of the skin. • In extreme cases the skin can crack and bleed and can spread to other parts of the body. • It can be extremely painful — bad enough to keep people off work and in some cases serious enough to force them to change jobs. Every year an estimated 66,000 people across all industries suffer from skin diseases caused or made worse by their work.

8. Health • Skin - Dermatitis • Some people are more prone to dermatitis than others, different substances and chemicals affect people differently. • How quickly you contract it depends on a number of things - • the substance • the strength or potency and • how long it is in contact with the skin • In our industry the most common substances that can cause dermatitis are; • Cement products • Fuel & oils • Resins and cleaning products • The best way of preventing dermatitis is to use a product that doesn't irritate the skin, where this cannot be achieved, the skin and hands must be covered to prevent risk of contact. • (Note; sometimes the protection we wear, e.g. latex gloves can sometimes cause dermatitis). About 10% of bricklayers leave the industry after developing allergic dermatitis from chromate's in cement

9. Health 2. Skin - Cancer Skin cancer is the most common form of cancer in the UK, with over 40,000 new cases diagnosed each year. People with pale skin are most at risk of skin damage, especially those with fair or red hair, with a lot of freckles or with a history of skin cancer. Exposure to ultraviolet rays (UV) radiation from the sun can cause skin damage including; Sunburn Blistering Skin ageing and in the long term can lead to skin cancer. A tan is a sign that the skin has been damaged

10. Health • Skin - Cancer • The HSE has produced a six—point code for sun protection. • Keep your top on, clothes form a barrier to the suns harmful rays. • Wear a hat with a brim or a flap that covers the ears and the back of the neck. • Stay in the shade if possible, during breaks and especially at lunch time. • Use a high factor sun screen of at least SPF15 on any exposed skin. • Drink plenty of water to avoid dehydration. • Check your skin regularly for any unusual moles or spots. See a doctor promptly if you find anything that is changing in shape, size, colour, itching or bleeding An operative uses a makeshift Sun Shade on his hard hat

11. Health 3. Respiratory Problems - Occupational Asthma Work related (occupational) asthma is an extremely distressing and potentially life threatening disease. Most cases occur as a result of employees being exposed to substances in the workplace that can be broadly classified as; Dusts Fibres Mists Gases Vapours Fumes Micro-organisms There are an estimated 1,500 to 3,000 new cases of occupational asthma each year

12. Health Occupational Asthma Asthma is a disease that causes narrowing of the airways and constricts breathing. The most common symptoms of asthma include: Wheezing Shortness of breath Tightness in the chest Very often the symptoms do not show themselves straight away and may take months or years to become noticeable.

14. Health Occupational Asthma The best way to prevent occupational asthma is to substitute known allergenic materials with those less likely to cause an allergy. Where this can not be achieved other measures such as good ventilation and local exhaust ventilation schemes can help reduce material concentrations in the air to an acceptable level. The final control is Respiratory Protective Equipment, this has to be selected very carefully as different types can give widely varying degrees of protection.

15. Selection of RPE Respiratory Protective Equipment, may be used to provide protection against a variety of substances with varying degrees of protection. You need to be aware that NO form of PPE provides complete protection. There is always some actual or potential leakage into the breathing zone. The Selection of RPE will consider: 1. Type of RPE. 2. Personal and work related factors. 3. Training. 4. Use of RPE. 5. Maintenance of RPE. 6. Storage of RPE. 7. Relative costs of RPE. Minimum Protection Factor = concentration outside face piece (MPF) max allowable concentration inside Compare MPF value with the assigned protection factor (APF) to identify the range of equipment required.

16. Health 4. Respiratory Problems - Asbestosis Asbestos is a naturally occurring mineral fibre that has been used in more than 3,000 different construction materials and manufactured products. It is commonly found in heating system insulation, wall and ceiling panels, roofing materials, floor tiles and a variety of other additional materials. Around 4000 people a year in United Kingdom die from diseases caused by past exposure to asbestos (HSE, www.hse.gov.uk) Asbestos fibres under a electron microscope All asbestos-containing materials were banned from 1999 All types of asbestos tend to break into very tiny fibres. These individual fibres are so small that many must be identified using a microscope. In fact, some individual fibres may be up to 700 times smaller than a human hair. Because asbestos fibres are so small, once released into the air, they may stay suspended there for hours or even days !

17. Health Asbestosis Asbestos fibres can have serious effects on your health if inhaled. The odds of getting cancer increase with the level and duration of exposure. Asbestos fibres can cause asbestosis, a scarring of the lungs that leads to breathing problems and heart failure. Workers who used to be involved with the manufacture or use asbestos products and have been exposed to high levels are often affected with asbestosis. The amount of time between exposure to asbestos and the first signs of disease can be as much as 30 years. It is known that smokers exposed to asbestos have a much greater chance of developing lung cancer than just from smoking alone. Inhalation of asbestos can also cause lung cancer and mesothelioma, a rare cancer of the lining of the chest and abdomen lining. It may be linked to cancer of the stomach and intestines, as well.

18. The Control Of Vibration At Work Regulations 2005 • Came into force on 6 July 2005 • Covers: • Hand Arm Vibration Syndrome (HAVS) • Whole-body Vibration (WBV) L141 L140

19. Health 5. Hand - Arm Vibration Syndrome • Hand Arm Vibration Syndrome (HAV's) is a disease linked to prolonged and regular use of hand held power tools, the most common condition is known as vibration white finger (VWF).Regular exposure to vibration can cause a range of permanent injuries to your hands and arms. • The injuries you could suffer include damage to your: • Blood circulatory system (white finger) • Sensory nerves • Muscles • Bones • Joints (Similar to arthritis) About half a million construction workers are at risk of vibration white finger from using vibrating tools

20. Health Hand - Arm Vibration Syndrome Early signs of the condition are a tingling sensation or pins and needles in the fingers accompanied by numbness. Ignoring these early warning signs may lead to further attacks when your fingers become white (See photos). In more severe forms the attacks are more frequent in the cold weather and may last up to an hour, causing considerable pain and loss of manual dexterity.

21. Health Hand - Arm Vibration Syndrome • HAVs could limit your ability to work. For example you may not be able to: • Continue working with vibrating equipment (which would make symptoms worse). • Work in cold or wet conditions (which could trigger painful attacks). • Carry out work requiring a high degree of manual dexterity (e.g. handling screws and nails) • The symptoms may also affect your family and leisure activities for the same reasons, for example: Fishing Swimming Golf Washing the car Gardening Fastening buttons or sorting out coins.

22. Health Hand - Arm Vibration Syndrome • Risks to individuals can be reduced by reviewing the task concerned by considering the hierarchy of control. • Can the operation be designed out ? • Is there an engineering solution ? – perform task mechanically. • Use low vibration equipment. • Use the correct tool for the job (maintained in good condition). • Isolation of workers – Job rotation. • Use of Personnel Protective Equipment. Remote controlled demolition pick Low Vibration Jack Hammer

23. Health Hand - Arm Vibration Syndrome There must be a better way ! An operative preparing a concrete joint using a single headed scabbler. When this photo was taken the operative had already been scabbling for two hours.

24. Health 6. Noise Induced hearing loss Noise induced hearing loss is one of the most common causes of ill health in industry—about 1.3 million workers are thought to be exposed to noise levels that could damage their hearing. Damage caused by noise is permanent and incurable—it can range from sounds appearing muffled to total deafness. People can also suffer from ‘tinnitus’ a constant ringing in the ears that can cause endless suffering. Other effects may include increased stress, reduced efficiency and disturbed sleep. Hearing difficulties in construction workers are roughly twice the national rate

25. The Control Of Noise at Work Regulations 2005 Control Measures : • Hearing protection made available at 80 dB(A) and 112 Pa • Hearing protection must be worn at 85 dB (A) and 140 Pa • Define areas, put up signs and control access at 85 dB(A) and 140 Pa where technically feasible.

26. Health • 7. Musculo-skeletal injury's • Musculo-skeletal disorders account for more cases of work related ill health in Great Britain than any other health hazard. • It is estimated that around 1.2 million individuals suffer from Musculo-skeletal disorders caused by their work. • Musculo-skeletal disorders describe a variety of; • Strains and Sprains • Over use problems affecting body muscles and joints • Areas most prone injury are; • Back • Neck • Shoulders and upper limbs

27. Health • 7. Musculo-skeletal injury's • Problems include a variety of aliments; • Herniated discs • Back ache • Pains • Swelling • Numbness • Repetitive Strain Injury ( R S I ) • Loss of strength in arms and hands • Upper Limb Disorders ( U L D ) • All of conditions may be caused or made worse by work, leisure or home activities or a combination of both.

28. Health • Other - Weils Disease • This is a serious and sometimes fatal infection that is transmitted to humans by contact with with urine from infected rats. • Symptoms start with a flu like illness with persistent and severe headaches. • Construction workers, farmers and people that work on canals and rivers are most at risk from contact and infection. • Bacteria suspended in the rats urine and contaminated water such as in sewers, ditches , ponds and slow flowing rivers can get into your body through; • Cuts and scratches • Lining of mouth, throat and eyes

29. Health • Weils Disease • Prevention - • Get rid of the source of the problem • Don’t touch them with unprotected hands • Cover all cuts, scratches and broken skin with a waterproof plaster before and during work • Wear protective clothing - gloves, overalls etc • Always wash your hands, before eating, drinking and smoking Remember ! If you feel unwell with similar symptoms always consult your doctor. A rat caught in the lights of pipe camera on an underground pipe survey

30. Summary For many years employee health has been on the back burner in construction - safety and safe management systems have been the main focus of attention. In recent times health and the management of health issues have come into the spotlight. On today's sites we must not only ensure the work is carried out in a safe manner but a healthy one for all concerned.

31. Further Reading Available from HSE Books For more information on health issues please contact your local safety adviser