Control of exposure to workplace carcinogens - introduction to a workshop

INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org

Practical steps to control exposure to workplace

carcinogens

John Cherrie

04/11/2023

OH2013 - Workplace Carcinogens 2

Plan for the workshop…

• Introduction (25 mins)• Four agents(15 mins each)

• Crystalline silica• Shift work involving night work• Diesel engine exhaust• Hardwood dust

• Final discussion (5 mins)

I hope that we can write a short article for the BOHS Exposure newsletter?

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We know what to do…• Minimise emission, release and spread of substances• Take into account all relevant routes of exposure• Control exposure by measures that are proportionate

to the health risk• Choose the most effective and reliable control

options• Where needed provide suitable personal protective

equipment• Review regularly all elements of controls• Inform and train all employees • Ensure control measures do not increase overall risk

http://www.hse.gov.uk/coshh/detail/goodpractice.htm

http://www.hse.gov.uk/coshh/detail/goodpractice.htm

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Control of exposure…

• Elimination • Substitution• Process modification• Ventilation• Isolation or segregation• Maintenance• Education and training• Personal protective equipment

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Control of exposure…

• Elimination• Substitution• Ventilation and control at source• Education and training• Personal protective equipment

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Substitution…• Successes

• Bladder cancer in the rubber industry and β-naphthylamine

• Toluene for benzene

• However, substitutions are complex and may have unexpected consequences• use of citrus oil rather than trichloroethylene, but… • d-limonene when oxidized presents risks as a skin

allergen

• Registries can promote substitution

• Plus, you have to get organisations to do it!

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ECEL…

• ECEL = Exposure Control Efficacy Library• Review of literature on the effectiveness of

enclosures, local ventilation and other controls at source• 90 peer-reviewed papers• Wide variation in effectiveness

• The data published since the ECEL report was prepared broadly supports the original analysis

• Effectiveness in experimental or semi-experimental studies higher than other situations

Fransman et al. Development and Evaluation of an Exposure Control Efficacy Library (ECEL). Annals of Occupational Hygiene (2008) vol. 52 (7) pp. 567-575.

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ECEL

Fransman et al. Development and Evaluation of an Exposure Control Efficacy Library (ECEL). Annals of Occupational Hygiene (2008) vol. 52 (7) pp. 567-575

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ECEL…

Risk Management Measure n Estimated efficacy

(%)

95% confidence interval

LEV in general 280 82 78 to 84

LEV + enclosure 9 86 69 to 94

Integrated 133 87 84 to 90

Mobile 4 61 -28 to 88

General ventilation 42 43 17 to 61

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Assigned Protection Factors

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Nicas M, Neuhaus J. Variability in Respiratory Protection and the Assigned Protection Factor. J Occup Environ Med 2004;1:99–109.

Effectiveness of repiratory protection…

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Effectiveness of behavioural interventions• Results from a systematic review

• 550 potentially relevant articles identified • 10 were considered informative

• Behavioural interventions had a limited positive impact upon exposure

• It’s not sufficient to just raise awareness of risks and controls, need to equip workers with skills to act on that knowledge

Lunt JA, Sheffield D, Bell N, et al. (2011) Review of preventative behavioural interventions for dermal and respiratory hazards. Occup Med (Lond);61:311–20.

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Control of exposure…• Elimination

• Does what it says on the tin!

• Personal protective equipment • Highly effective if you can get good compliance

• Substitution• Potentially effective, but may be difficult to achieve in

practice

• Ventilation and control at source• Very variable effectiveness, between locations

• Education and training• No appreciable effect

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How do you get people to act?• Introduce new OELs?• Provide free guidance material?• Offer compliance support for organisations?• Develop cost-effective technologies?• Offer financial support to SMEs to introduce new

technology?• Strictly enforce the law, e.g. COSHH?• Require the introduction of new technology?• Ban the use of the agent?• Or something else.

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Crystalline silica…• IARC 1 – lung cancer• 5.3m exposed in Europe (4m in construction)

• Movement of earth (e.g. mining, quarrying, tunnelling)• Crushing or grinding of silica containing material such as

concrete, aggregate or mortar• Sandblasting• Use of silica, sand or silica containing products in the

manufacture of glass and other non-metallic mineral products

• Use of sand in foundries

• Geometric mean exposure 0.07 mg/m3 with a GSD of about 5 (i.e. about 50% exceed 0.05 mg/m3).

• Maybe 7,000 deaths per year from past exposure• OELs: mostly between 0.05 and 0.1mg/m3

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Shift work…• IARC 2a – female breast cancer• Perhaps 25,000 cases each year in Europe due to

shift working• 15 – 20% workers work nights

• Health• Machine ops• Hotels, catering etc.• Transport • Wholesale

• No OELs, but risk highest for after midnight and rotating night shift, particularly >500 shifts in lifetime

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Diesel engine exhaust…• IARC 1 – lung cancer and bladder cancer• 3.6m people exposed in Europe

• Mining and quarrying• Construction• Transport

• 4,500 deaths per year in Europe• Geometric mean exposure levels: 0.06 mg/m3 in

mining, 0.014 mg/m3 in transport (GSD about 3)• Very few countries with OELs. Typical values around

0.1 mg/m3, but a “safe” limit would be around 0.01 mg/m3

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Hardwood dust…• IARC 1 – sinonasal and nasopharyngeal cancer• 3m people exposed in Europe

• Manufacture wood products• Joinery• Boat building

• About 160 deaths per year• Geometric mean exposure in boat building

about 2 mg/m3 and otherwise about 0.5 mg/m3 (GSD 4)

• OELs between 1 and 5 mg/m3

Control of exposure to workplace carcinogens - introduction to a workshop

Health & Medicine

Transcript of Control of exposure to workplace carcinogens - introduction to a workshop