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    HEALTH SURVEILLANCE FOR THOSE EXPOSED TO SILICA

    Report by HSL considers appropriate health surveillance standards

    HSE is seeking to establish a standard for the health surveillance of respirable crystalline silica (RCS). There is currently uncertainty about what constitutes appropriate health surveillance for silica-exposed workers, despite evidence that new cases of silicosis are occurring.

    The Health and Safety Laboratory (HSL) were therefore commissioned by HSE to:

    1. identify existing recommendations for health surveillance for silica-exposed workers;
    2. assess the evidence base for these recommendations and evidence in the scientific literature; and
    3. make recommendations for a standard approach to health surveillance for silica-exposed workers.

    HSL has now published a report RR827: Health surveillance in silica exposed workers

    Main findings

    The report identifies the following main findings:

    • health surveillance programmes for RCS-exposed workers are important for identifying early adverse respiratory effects;
    • programmes should take into account regular and up-to date measures or estimates of individual worker exposure to RCS;
    • baseline assessment of respiratory health for potentially RCS-exposed workers is needed with a subsequent annual assessment. Both should include use of a ‘standardised’ questionnaire and lung function measures (although an agreed standard questionnaire or data recording proforma is currently not available); and
    • there is no agreed consensus on (a) how best to interpret lung function changes over time and (b) relating to the periodicity of chest radiographs required to identify changes of silicosis, although various approaches are suggested.
    Recommendations

    The report makes the following recommendations:

    1. health surveillance for RCS-exposed workers should be based upon the findings of appropriate workplace risk assessments.
    2. overall acceptance of RCS-based health surveillance by workers is key to success and programmes should be developed in close consultation with workers;
    3. programmes should make it explicitly clear to workers how they will be individually handled should they be noted to have abnormal results during testing;
    4. records should be shared with the individual worker, passed on (with consent) to the primary care provider and kept separate from human resources within an organisation;
    5. a standardised approach should be developed for health surveillance and should include a number of key elements (see Section 8.2.1). Consideration should be given to developing a standardised questionnaire and a health surveillance data recording proforma;
    6. those responsible for developing and delivering programmes require knowledge of the adverse health effects of RCS exposure, and of lung function and radiological abnormalities; and
    7. further work should be undetaken to gain a better understanding of the ideal periodicity of the various components of health surveillance and of predictive factors that are associated with the development of silicosis, accelerated lung function decline and COPD.
    Comment

    HSE has been taking steps to raise the profile of controlling exposure to silica dust within the construction industry. Enforcement activity on silica exposure risks increased seven-fold from 2008/09 to 2009/10 with approximately 100 Notices served by inspectors.

    This follows the Time to clear the air’ initiative and interim guidance on the control of silica risks associated with the cutting of roof tiles

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