A safer conversation: respiratory disease - Part I

Work-related respiratory diseases are caused or made worse by breathing in hazardous substances that damage the lungs, such as dusts, fumes and gases. The most prevalent of these diseases are chronic obstructive pulmonary disease (COPD), asthma and silicosis. Every year 13,000 people die in the UK as a result of these conditions.

Why, despite having the legislation in place and the campaigns for years, is the issue still so prevalent

Alan: The prevalence of work-related respiratory illness is highlighted in the latest Health and Safety Executive stats published in October 2016, showing 13,000 associated deaths each year due to occupational respiratory disease, but also highlighting 36,000 individuals reporting breathing or lung problems they believed were caused or exacerbated by work. The issue perhaps remains because there has not been a cohesive drive to solve the problem with coordinated support from the NHS and other instrumental organisations.

In an effort to start improving these statistics, HSE launched the 2016 Helping Great Britain Work Well scheme with a greater focus on occupational health than before. The HSE is keen to include organisations such as the NHS and to start driving the critical behavioural change and awareness programmes.

The BSIF believes that the country and the NHS already sees the benefits of improving occupational health outcomes, together with the Department for Work and Pensions and the Department for Business, Energy and Industrial Strategy. The disconnect, and the prevailing issue, could be within these institutions and their relationships with local government.

In a bid to start improving the current situation and to make occupational health part of the public health agenda, the BSIF recently commissioned a report into local authority spending on work-related respiratory health. Of the 402 councils that were contacted, just 217 reported any funding to respiratory health, and only four were related to work related projects.

The Federation has created a report for local authorities that provides clear recommendations on how to bolster current strategies and ensure public health spend achieves better outcomes. More than 31 million people are now in work and it is vital that we act now to ensure their health and wellbeing is not compromised through their jobs.

Occupational health is public health and must start to be treated as such.

Kevin: There is still a disparity between health and safety in the workplace. While safety has been ingrained into our working culture for many years, and statistics over the last 20 years have fallen in these areas, the health side has not been focussed on as much.

Campaigns run by BSIF, BOHS, Working Well Together and Healthy Working Lives have provided great information to industry around respiratory illnesses, and the message is certainly getting out there. The message is harder to reach small and middle enterprises (SME) and self-employed workers who may not be aware of the dangers until is too late.

The latency period of respiratory diseases is not instantaneous, sometimes 30 or more years. Those working with the hazards do not understand how it may be affecting them throughout their working life until it is too late.

There is still an attitude of ‘it won’t happen to me’, but this is slowly changing as figures such as those above are published.

Luca: One reason for this is the ‘compliance-driven’ safety culture that is still prevalent among some employers. Particularly in the current economic climate, some organisations may see personal protective equipment as a cost that should be kept to a minimum. As a result, they will provide workers with the correct respiratory protective equipment (RPE) and sometimes deliver basic training, but – as long as they comply with the basic legal requirements – their efforts end there. In other words, employees are provided with the equipment for the job and are expected to know how to use it correctly. This approach is clearly not enough to ensure workers use their RPE correctly to help avoid respiratory disease.

Businesses need to realise that the benefits of investing in the correct RPE and ensuring that workers are properly trained and educated about respiratory risks as well as how to properly use the equipment will do more than improve their long-term health prospects. It will also help improve productivity. If properly fitted and trained on the RPE, workers will feel more comfortable and protected, helping them concentrate on the job at hand.

Mike: This shocking statistic (13,000 deaths a year) is a clear indication that there is still a huge lack of awareness about the risks in the workplace, which are causing these diseases, how to recognise these risks and more importantly, how to control them.

If you take the overall picture of occupational health, it is our view that employers have focused on the treatment of existing conditions, health surveillance, fitness for work, rehabilitation, sickness absence management, health promotion and lifestyle choices – the domains of clinical occupational health and of wellbeing.

While this is all good and necessary, these aspects won’t prevent workers from being made ill by the work they are doing. For this, we need to protect people from workplace health risks, which is the domain of occupational hygiene. This is where the lack of awareness comes in: employers aren’t fully aware of the crucial role of occupational hygiene in controlling risks to health.

If we are serious about worker health, we need a three-way partnership between clinical occupational health, occupational hygiene, and wellbeing.

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The risks of exposure from working in construction are greater than in any other sector. The Breathe Freely campaign launched in April 2015 aimed to prevent occupational lung disease in construction. Can you evaluate the results so far

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Alan: The Breathe Freely campaign has built a new community of organisations within the construction industry who are all now more committed to worker respiratory health than before, and are armed with greater knowledge. Partners include HSE, Constructing Better Health, Land Securities and Mace. The BSIF is very proud to be one of the official supporters of the campaign.

The research by BOHS identified the clear problem of lung disease in the construction industry and provided a practical, workable solution. This included a management standard suitable for health and safety managers on construction sites, a construction manager’s toolkit, and guides and factsheets and best practice case studies. This material provided information including a concise summary of the key health hazards, specific breakdowns for specific trades, control options for managing the risks and the current exposure limits.

In April 2016, a revised version of the management standard was unveiled, designed to set out exactly what ‘good’ looks like in managing health risks for managers and their organisations. The BOHS truly answers the questions they face during the campaign events and roadshows, and ensure they are providing tailored information to their audience on managing health effectively.

Kevin: I think it is still too early to tell the results of the Breathe Freely campaign, but this has been one of the strongest campaigns on the subject. As with all campaigns, it is how we can get the message out to the wider population. The initial figures have been a shock to industry and certainly brought work-related respiratory illnesses to the forefront.

As part of a team that conducts face- fit testing, the number of enquiries for face-fit testing in the construction sector has nearly doubled in the last two years. A lot of this is orchestrated by principal contractors, which is great to see.

A large number within this industry are still reactionary following the enforcement authority.

Mike: We at BOHS have been delighted with the unprecedented levels of support the Breathe Freely initiative has attracted in its first 18 months. We have signed up over 160 supporters from across the construction industry, including our founding partners and now many other employers, trade unions, influential people and organisations.

We hope that the increased support and take-up of our guidance means that employers are becoming more aware of what the hazards are, how they can control them, and that they are putting these safeguards in place.

The challenge we face is that work-related lung hazards such as asbestos and silica dust are invisible and silent. Moreover, the effects of these hazards have a long latency. Unlike a workplace accident, where the tragic consequences are immediately clear for all to see, the effects, of breathing in silica dust during abrasive blasting work, for example, will take many years to become apparent.

These complexities make it difficult to measure the progress of the Breathe Freely initiative immediately, since we will only have proof of our success in years to come when we see the illness and mortality figures declining, which, of course, is what we greatly hope for.

However, right now, our Breathe Freely campaign is based on the simple premise that we can protect workers’ health and actually prevent deaths caused by lung cancer and other respiratory diseases through good occupational hygiene practice. To put it simply, by recognising the hazards, evaluating the risks and controlling exposures today, we can make a huge difference to worker health in years to come.

We are currently planning a new phase of the Breathe Freely campaign, aimed at the manufacturing industry, focusing on the issues around welding fumes which can cause cancer and other respiratory diseases. This will be launched in April 2017, and as well as having the HSE and the EEF on board, we also have The Welding Institute, TUC amongst others as partners for this initiative. This will run alongside the construction industry campaign which will continue into 2017.

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Research by the BSIF shows that up to half of the RPE currently in use in the UK market does not provide the wearer with the level of protection expected, typically because the RPE does not fit the individual as it should. What is the employee role in getting it right

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Alan: The British Safety Industry Federation created the Fit2Fit Accreditation scheme in conjunction with HSE, so that the competence of people carrying out RPE face-fit tests for those wearing the equipment could be established. This enables both managers and employees to have confidence in RPE face fitting and that it will help to reduce respiratory diseases. Typically, 35% of individuals who sat the Fit2Fit accreditation scheme failed to demonstrate competency, illustrating that there remains a problem.

For all tight fitting RPE face pieces, including disposable masks, half masks and full face masks, it is a UK legal requirement that, at initial selection of the product for the employee, the face piece is specifically fit-tested to the wearer. Such RPE must be adequate and suitable. Adequate means that the RPE is correct for the hazard and exposure is reduced, meaning worker health is protected. Suitable means that the RPE is right for the wearer, the task and the environment, and the worker is able to work freely without additional risks from the RPE. In order for the RPE to be effective, the equipment absolutely must be of the correct size and fit the wearer’s face.

To achieve the Fit2Fit accreditation, an individual must demonstrate competence in RPE face-fitting as dictated by HSE guidance. HSE inspectors recognise the accreditation as evidence of the competence of the face-fit testing carried out.

The Fit2Fit Accreditation provides a fundamental seal of approval for managers and employees alike. To ensure they have the correct RPE suited for their specific requirements; employers should insist that their face-fit provider has been deemed competent via the Fit2Fit Accreditation. Managers can find accredited face-fit testers via the Fit2Fit website.

Kevin: On introducing RPE into the workplace following the correct selection process, the managers need to ensure the employees are sufficiently trained in the wearing, use and maintenance of the RPE they have been given. Guidance to what should be included in this training is given in HSG53, but more often than not, wearers are only given a quick tool box if anything at all on how to wear the RPE. This is particularly prevalent with disposable respirators, which are widely used with some of the main causes of respiratory illnesses.

As mentioned earlier in this conversation, in conjunction with the training, a face-fit test should be conducted at the initial selection phase, to make sure that a tight fitting respirator fits the individual without leaking at the seal. This must be done while clean shaven, as stubble or facial hair within the seal of the RPE could affect the performance. It is important to have the face-fit test carried out by a competent person to help prevent a wearer using a respirator which does not fit.

Once trained and successfully fit- tested, the individual must inspect, maintain and continue to wear the RPE as shown, while clean shaven (a wet shave – rather than clippers). Any change in physical characteristics by the employee should be mentioned to prompt a re-test.

Luca: Three main factors influencing worker protection with regard to RPE are product quality, proper fit and appropriate application.

In terms of the first point, there are still many products on the market that don’t provide the right level of protection because of their low quality. Unfortunately, these products are still attractive to many companies, particularly in the current environment where businesses are looking to cut costs. Price not only reflects product quality, it may indicate protective ability.

Among the products that have at least an acceptable level of quality, there is the problem of the fit. This is due to the structure of the face – the size and shape.

The third factor is how the worker uses the RPE. A good product that can adapt to the unique contours of every face and is worn in the proper way gives the right level of protection.

But the most important person when it comes to RPE is the worker. Unfortunately, many workers still don’t use their RPE properly, either because they are not well trained on it or because it’s not comfortable to them. Either they don’t wear it to begin with, or they’ll remove the RPE while they are working.

Other than ensuring that the RPE fit is correct on the worker, safety managers should ensure that employees are properly trained on how to use RPE correctly. They really need to raise awareness of the risks that workers face and campaigns can help support this. They also need to provide workers with quality products that they are happy to use and that are comfortable to wear.

If workers are really not sure about how to use the RPE, they should ask for training without any hesitation. Any time that they have any doubts about the current fit of their RPE, they should ask for a check. We are talking about their health. If they are not comfortable, they need to ask for help rather than choose not to use it.

Mike: RPE can be used to control inhalation of hazardous substances at work to help prevent serious lung conditions caused by inhaling dust and other contaminants. However, it is important to remember that RPE should be considered as a primary control when other measures, such as containment and local extraction, cannot reduce contaminant concentrations down to an acceptable level.

Beside what has been said about the use of right equipment and testing, for the RPE to be effective, workers need to understand why it is needed, how to wear it and how to use it correctly. Plus, with reusable devices, workers are required to know how to maintain them and when to replace the filter.

Workers need to ensure they are following instructions carefully regarding the RPE. However, it is also important that employers have made them aware of the risks: if they know the potential consequences to their health of not wearing their RPE correctly, then they may be more likely to use it.

New guide to managing RPE in construction will be available in early 2017 via Breathe Freely website

More info on Fit2Fit here