Systems of workplace injury and illness surveillance constitute a critical resource for management and reduction of occupational injuries and illnesses. They provide essential data which can be used to identify workplace problems, develop corrective strategies and thus prevent future injuries and illnesses. To accomplish these goals effectively, surveillance systems must be constructed which capture the characteristics of workplace injuries in considerable detail. To be of maximum value, such a system should be able to provide answers to such questions as which workplaces are the most hazardous, which injuries produce the most time lost from work and even what part of the body is injured most frequently.

This article describes the development of an exhaustive classification system by the Bureau of Labor Statistics of the United States Department of Labor (BLS). The system was developed to meet the needs of a variety of constituencies: state and federal policy analysts, safety and health researchers, employers, employee organizations, safety professionals, the insurance industry and others involved in promoting safety and health in the workplace.

Background

For a number of years, the BLS has collected three basic types of information concerning an occupational injury or illness:

  • industry, geographic location of the incident and any associated lost workdays
  • characteristics of the affected employee, such as age, gender and occupation
  • how the incident or exposure occurred, the objects or substances involved, the nature of the injury or illness and part of the body affected.

 

The previous classification system, though useful, was somewhat limited and did not fully meet the needs described above. In 1989 it was decided that a revision of the existing system was in order that would best suit the needs of the varied users.

The Classification System

A BLS task force was organized in September 1989 to establish requirements for a system that would “accurately describe the nature of the occupational safety and health problem” (OSHA 1970). This team worked in consultation with safety and health specialists from the public and private sectors, with the goal of developing a revamped and expanded classification system.

Several criteria were established governing the individual code structures. The system must have a hierarchical arrangement to allow maximum flexibility for varied users of occupational injury and illness data. The system should be, to the extent possible, compatible with the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) of the WHO (1977). The system should meet the needs of other government agencies involved in the safety and health arena. Finally, the system must be responsive to the differing traits of nonfatal and fatal cases.

Drafts of the case characteristic classification structures were produced and released for comment in 1989 and again in 1990. The system included nature of injury or illness, part of body affected, source of injury or illness, event or exposure structures and secondary source. Comments were received and incorporated from bureau staff, state agencies, Occupational Safety and Health Administration, Employment Standards Administration and NIOSH, after which the system was ready for an onsite test.

Pilot testing of the structures for compiling data for nonfatal injuries and illnesses, as well as the operational application in the Census of Fatal Occupational Injuries, was conducted in four states. Test results were analysed and revisions completed by the fall of 1991.

The final 1992 version of the classification system consists of five case characteristic code structures, an occupational code structure and an industry code structure. The Standard Industrial Classification Manual is used to classify industry (OMB 1987), and the Bureau of the Census Alphabetical Index of Occupations for coding occupation (Bureau of the Census 1992). The BLS Occupational Injury and Illness Classification System (1992) is used to code the following five characteristics:

  • nature of injury or illness
  • part of body affected
  • event or exposure
  • source of injury or illness
  • secondary source of injury or illness.

Besides numerical codes that represent specific conditions or circumstances, each code structure includes aids to assist in identification and selection of the proper code. These aids include: definitions, rules of selection, descriptive paragraphs, alphabetical listings and edit criteria for each of the structures. The rules of selection offer guidance to choose the appropriate code uniformly when two or more code selections are possible. The descriptive paragraphs provide additional information about the codes such as what is included or excluded in a particular code. For instance, the code for eye includes the eyeball, the lens, the retina and the eyelashes. The alphabetical listings can be used to quickly find the numerical code for a specific characteristic, such as medical terminology or specialized machinery. Finally, edit criteria are quality-assurance tools that can be used to determine which code combinations are incorrect prior to final selection.

Nature of injury or illness codes

The nature of injury or illness code structure describes the principal physical characteristic of the worker’s injury or illness. This code serves as the basis for all other case classifications. Once the nature of injury or illness has been identified, the remaining four classifications represent the circumstances associated with that particular outcome. The classification structure for nature of injury of illness contains seven divisions:

  • traumatic injuries and disorders
  • systemic diseases or disorders
  • infectious and parasitic diseases
  • neoplasms, tumours and cancer
  • symptoms, signs and ill-defined conditions
  • other conditions or disorders
  • multiple diseases, conditions or disorders.

 

Before finalizing this structure, two similar classifications systems were evaluated for possible adoption or emulation. Because the American National Standards Institute (ANSI) Z16.2 standard (ANSI 1963) was developed for use in accident prevention, it does not contain a sufficient number of illness categories for many agencies to accomplish their missions.

The ICD-9-CM, designed for classifying morbidity and mortality information and used by a large portion of the medical community, provides the required detailed codes for illnesses. However, technical knowledge and training requirements for users and compilers of these statistics made this system prohibitive.

The final structure arrived at is a hybrid which combines the application method and rules of selection from the ANSI Z16.2 with the basic divisional organization from the ICD-9-CM. With few exceptions, divisions in the BLS structure can be directly mapped to the ICD-9-CM. For example, the BLS division identifying infectious and parasitic diseases maps directly to Chapter 1, Infectious and Parasitic Diseases, of the ICD-9-CM.

The first division in the BLS nature of injury or illness structure classifies traumatic injuries and disorders, effects of external agents and poisoning, and corresponds to Chapter 17 of the ICD-9-CM. Outcomes in this division are generally the result of a single incident, event or exposure, and include conditions such as fractures, bruises, cuts and burns. In the occupational environment, this division accounts for the great majority of reported cases.

Several situations required careful consideration when establishing rules to select codes in this division. Review of fatality cases revealed difficulties in coding certain types of fatal injuries. For example, fatal fractures usually involve direct or indirect mortal damage to a vital organ, such as the brain or spinal column. Specific coding categories and instructions were required to note the mortal damage associated with these types of injuries.

Gunshot wounds constitute a separate category with special instructions for those instances in which such wounds also resulted in amputations or paralysis. In keeping with an overall philosophy of coding the most serious injury, paralysis and amputations take precedence over less serious damage from a gunshot wound.

Responses to questions on employer reporting forms concerning what happened to the injured or ill worker do not always adequately describe the injury or illness. If the source document indicates only that the employee “hurt his back”, it is not appropriate to assume this is a sprain, strain, dorsopathy or any other specific condition. To solve the problem, individual codes were established for non-specific descriptions of injury or illness like “sore,” “hurt” and “pain”.

Finally, this division has a section of codes to classify the most frequently occurring combinations of conditions that result from the same incident. For example, a worker may suffer both scratches and bruises from a single incident.

Five of the remaining divisions of this classification structure were devoted to identification of occupational diseases and disorders. These sections present codes for specific conditions that are of paramount interest to the safety and health community. In recent years, a growing number of diseases and disorders have been linked to the work environment but were seldom represented in the existing classification structures. The structure has a vastly expanded list of specific diseases and disorders such as carpal tunnel syndrome, Legionnaire’s disease, tendonitis and tuberculosis.

Part of body affected

The part of body affected classification structure specifies the part of the body which was directly affected by the injury or illness. When linked with the nature of injury or illness code, it provides a more complete picture of the damage incurred: amputated finger, lung cancer, fractured jaw. This structure consists of eight divisions:

  • head
  • neck, including throat
  • trunk
  • upper extremities
  • lower extremities
  • body systems
  • multiple body parts
  • other body parts.

 

Three issues surfaced during evaluation of redesign options for this theoretically simple and straightforward piece of the classification system. The first was the merit of coding external location (arm, trunk, leg) of the injury or illness versus the affected internal site (heart, lungs, brain).

Test results indicated that coding the internal part of body affected was appropriate for diseases and disorders, but extremely confusing when applied to many traumatic injuries such as cuts or bruises. The BLS developed a policy of coding the external location for most traumatic injuries and coding internal locations, where appropriate, for diseases.

The second issue was how to handle diseases that affect more than one body system simultaneously. For instance, hypothermia, a condition of low body temperature due to exposure to the cold, can affect the nervous and endocrine systems. Because it is difficult for nonmedical personnel to determine which is the appropriate choice, this could lead to a tremendous amount of research time with no clear resolution. Therefore, the BLS system was designed with a single entry, body systems, that categorizes one or more body systems.

Adding detail to identify typical combinations of parts in the upper extremities and the lower extremities was the third major enhancement to this code structure. These combinations, such as hand and wrist, proved to be supportable by the source documents.

Event or exposure

The event or exposure code structure describes the manner in which the injury or illness was inflicted or produced. The following eight divisions were created to identify the primary method of injury or exposure to a harmful substance or situation:

  • contact with objects and equipment
  • falls
  • bodily reaction and exertion
  • exposure to harmful substances or environments
  • transportation accidents
  • fires and explosions
  • assaults and violent acts
  • other events or exposures.

Injury-producing incidents are frequently composed of a series of events. To illustrate, consider what occurs in a traffic accident: A car hits a guard-rail, crosses the median strip and collides with a truck. The driver has several injuries from striking parts of the car and being struck by broken glass. If the micro-events—such as hitting the windshield or being struck by flying glass—were coded, the overall fact that the person was in a traffic accident could be missed.

In these multiple event instances, the BLS designated several occurrences to be considered primary events and to take precedence over other micro-events associated with them. These primary events included:

  • assaults and violent acts
  • transportation accidents
  • fires
  • explosions.

An order of precedence was established within these groups as well because they frequently overlap—for example, a highway accident can involve a fire. This order of precedence is the order which they appear in the above list. Assaults and violent acts were assigned first precedence. Codes within this division generally describe the type of violence, while the weapon is addressed in the source code. Transportation accidents are next in precedence, followed by fires and explosions.

These last two events, fires and explosions, are combined in a single division. Because the two often occur simultaneously, an order of precedence between the two had to be established. In accordance with the ICD-9 Supplementary Classification of External Causes, fires were given precedence over explosions (USPHS 1989).

Selection of codes for inclusion in this structure was influenced by the emergence of non-contact disorders that are associated with the activities and ergonomics of the job. These cases typically involve nerve, muscle or ligament damage brought about by exertion, repetitive motion and even simple body motions such as when the worker’s back “goes out” when reaching over to pick up an item. Carpal tunnel syndrome is now widely recognized to be tied to repetitive actions such as key entry, typing, cutting actions and even operating a cash register. The division bodily reaction and exertion identifies these non-contact, or non-impact, incidents.

The event division “exposure to harmful substances or environments” distinguishes the specific method of exposure to toxic or harmful substances: inhalation, skin contact, ingestion or injection. A separate category to identify the transmission of an infectious agent through a needle stick was developed. Also included in this division are other non-impact incidents in which the worker was harmed by electric power or by environmental conditions, such as extreme cold.

Contact with objects and equipment and falls are the divisions that will capture most impact events that injure workers.

Source of injury or illness

The source of injury or illness classification code identifies the object, substance, bodily motion or exposure which directly produced or inflicted the injury or illness. If a worker is cut on the head by a falling brick, the brick is the source of injury. There is a direct relationship between the source and the nature of the injury or illness. If a worker slips on oil and falls to the floor, breaking an elbow, the fracture is produced by hitting the floor, so the floor is source of injury. This code system contains ten divisions:

  • chemicals and chemical products
  • containers
  • furniture and fixtures
  • machinery
  • parts and materials
  • persons, plants, animals and minerals
  • structures and surfaces
  • tools, instruments and equipment
  • vehicles
  • other sources.

The general definitions and coding concepts for the new BLS Source Classification Structure were carried over from the ANSI Z16.2 classification system. However, the task of developing a more complete and hierarchical code listing was initially daunting, since virtually any item or substance in the world can qualify as a source of injury or illness. Not only can everything in the world qualify as source, so can pieces or parts of everything in the world. To add to the difficulty, all candidates for inclusion in the source codes had to be grouped into only ten divisional categories.

Examination of historical data on work injuries and illness identified areas where the previous code structure was inadequate or out of date. The machinery and tools sections needed expansion and updating. There was no code for computers. Newer technology had made the list of power tools obsolete, and many items listed as nonpowered tools were now almost always powered: screwdrivers, hammers and so on. There was a demand from users to expand and update the list of chemicals in the new structure. The US Occupational Safety and Health Administration requested expanded detail for a variety of items, including several types of scaffolds, forklifts and construction and logging machines.

The most difficult aspect of developing the source structure was organizing the items required for inclusion into distinct divisions and groups within the division. To add to the difficulty, the source code categories had to be mutually exclusive. But no matter what categories were developed, there were many items that logically fit in two or more divisions. For example, there was general agreement that there should be separate categories for vehicles and for machines. However, reviewers disagreed about whether certain equipment such as road pavers or forklifts, belonged with machines or vehicles.

Another area of debate developed on how to group the machines within the machinery division. The options included associating machines with a process or an industry (for example, agricultural or garden machines), grouping them by function (printing machines, heating and cooling machinery) or by type of object processed (metal working, woodworking machines). Unable to find a single solution which was workable for all types of machines, the BLS compromised with a listing that uses an industry function for some groups (agricultural machines, construction and logging machines), general function for other groups (material handling machines, office machines), and some material-specific functional groupings (metalworking, woodworking). Where the possibility of overlap occurred, such as a woodworking machine used for construction work, the structure defined the category to which it belonged, to keep the codes mutually exclusive.

Special codes were added to capture information on injuries and illnesses occurring in the health care industry, which has emerged as one of the largest employment sectors in the United States, and one with serious safety and health problems. As an example, many of the participating state agencies recommended inclusion of a code for patients and residents of health care facilities, since nurses and health aides can be hurt while trying to lift, move or otherwise care for their patients.

Secondary source of injury or illness

The BLS and other data users recognized that the occupational injury and illness source classification structure captures the object that produced the injury or illness but sometimes fails to identify other important contributors to the event. In the previous system, for example, if a worker was struck by a piece of wood that flew off a jammed saw, the wood was the source of injury; the fact that a power saw was involved was lost. If a worker was burned by fire, the flame was selected as the source of injury; one could not also identify the source of the fire.

To make up for this potential loss of information, the BLS developed a secondary source of injury or illness which “identifies the object, substance, or person that generated the source or injury or illness or that contributed to the event or exposure”. Within the specific rules of selection for this code, the emphasis is on identifying the machines, tools, equipment or other energy-generating substances (such as flammable liquids) that are not identified through source classification. In the first example noted above, the power saw would be the secondary source, since it threw out the piece of wood. In the latter example, the substance that ignited (grease, gasoline and so on) would be named as the secondary source.

Implementation Requirements: Review, Verification and Validation

Establishing a comprehensive classification system is only one step in assuring that accurate information concerning workplace injuries and illnesses is captured and available for use. It is important that workers in the field understand how to apply the coding system accurately, uniformly and according to the system design.

The first step in quality assurance was to thoroughly train those who will be assigning the classification system codes. Beginning, intermediate and advanced courses were developed to assist in uniform coding techniques. A small group of trainers was charged with delivering these courses to concerned personnel throughout the United States.

Electronic edit checks were devised to assist in the review, verification and validation process for the case characteristic and demographic estimates. Criteria of what can and cannot be combined were identified and an automated system to identify those combinations as errors was put into place. This system has over 550 groups of cross check which verify that the incoming data meet quality checks. For example, a case that identified carpal tunnel syndrome as affecting the knee would be deemed an error. This automated system also identifies invalid codes, that is, codes that do not exist in the classification structure.

Clearly, these edit checks cannot be sufficiently stringent to capture all suspect data. The data should be examined for overall reasonableness. For example, over the years of collecting similar data for the part of body, nearly 25% of the cases named the back as the affected area. This gave review staff a benchmark for validating data. A review of cross tabulations for overall sensibility also gives insight into how well the classification system was applied. Finally, special rare events, such as work-related tuberculosis, should be validated. One important element of a comprehensive validation system could involve recontacting the employer to insure the accuracy of the source document, although this requires additional resources.

Examples

Selected examples from each of the four illness and injury classification coding systems are shown in table 1 in order to illustrate the level of detail and the resulting richness of the final system. The power of the system as a whole is demonstrated in table 2, which shows a variety of characteristics that were tabulated for one set of related injury types—falls. In addition to total falls, the data are further subdivided into falls on the same level, falls to a lower level and jumping to a lower level. It can be seen, for instance, that falls were most likely to occur to workers age 25 to 34 years old, to operators, fabricators and labourers, to workers in the manufacturing industries and to workers with less than five years of service to their current employer (data not shown). The accident was most often associated with work on a floor or ground surface, and the subsequent injury was most likely to be a sprain or strain affecting the back, resulting in the worker spending more than one month away from work.

 


Table 1. Nature of injury or illness code—Examples

 

Nature of injury or illness code-Examples

0* Traumatic Injuries and Disorders

08*                                    Multiple traumatic injuries and disorders

080                              Multiple traumatic injuries and disorders, unspecified

081                              Cuts, abrasions, bruises

082                              Sprains and bruises

083                              Fractures and burns

084                              Fractures and other injuries

085                              Burns and other injuries

086                              Intracranial injuries and injuries to internal organs

089                              Other combinations of traumatic injuries and disorders, n.e.c.

Event or exposure code-Examples

1* Falls

11*                                   Fall to lower level

113                              Fall from ladder

114                              Fall from piled or stacked material

115*                            Fall from roof

1150                  Fall from roof, unspecified

1151                  Fall through existing roof opening

1152                  Fall through roof surface

1153                  Fall through skylight

1154                  Fall from roof edge

1159                  Fall from roof, n.e.c.

116                    Fall from scaffold, staging

117                    Fall from building girders or other structural steel

118                    Fall from nonmoving vehicle

119                    Fall to lower level, n.e.c.

Source of injury or illness code-Examples

7*Tools, instruments and equipment

72*                                     Handtools-powered

722*                              Cutting handtools, powered

7220                   Cutting handtools, powered, unspecified

7221                   Chainsaws, powered

7222                   Chisels, powered

7223                    Knives, powered

7224                    Saws, powered, except chainsaws

7229                    Cutting handtools, powered, n.e.c.

723*                               Striking and nailing handtools, powered

7230                    Striking handtools, powered, unspecified

7231                    Hammers, powered

7232                    Jackhammers, powered

7233                    Punches, powered

Part of body affected code-Examples

2* Trunk

23*                                   Back, including spine, spinal cord

230                              Back, including spine, spinal cord, unspecified

231                              Lumbar region

232                              Thoracic region

233                              Sacral region

234                              Coccygeal region

238                              Multiple back regions

239                              Back, including spine, spinal cord, n.e.c.

* = division, major group, or group titles; n.e.c. = not elsewhere classified.


 

Table 2. Number and percentage of nonfatal occupational injuries and illnesses with days away from work involving falls, by selected worker and case characteristics, US 19931

Characteristic

All events

All falls

Fall to lower level

Jump to lower level

Fall on same level

 

Number

%

Number

%

Number

%

Number

%

Number

%

Total

2,252,591

100.0

370,112

100.0

111,266

100.0

9,433

100.0

244,115

100.0

Sex:

Men

1,490,418

66.2

219,199

59.2

84,868

76.3

8,697

92.2

121,903

49.9

Women

735,570

32.7

148,041

40.0

25,700

23.1

645

6.8

120,156

49.2

Age:

14 to 15 years

889

0.0

246

0.1

118

0.1

84

0.0

16 to 19 years

95,791

4.3

15,908

4.3

3,170

2.8

260

2.8

12,253

5.0

20 to 24 years

319,708

14.2

43,543

11.8

12,840

11.5

1,380

14.6

28,763

11.8

25 to 34 years

724,355

32.2

104,244

28.2

34,191

30.7

3,641

38.6

64,374

26.4

35 to 44 years

566,429

25.1

87,516

23.6

27,880

25.1

2,361

25.0

56,042

23.0

45 to 54 years

323,503

14.4

64,214

17.3

18,665

16.8

1,191

12.6

43,729

17.9

55 to 64 years

148,249

6.6

37,792

10.2

9,886

8.9

470

5.0

27,034

11.1

65 years and over

21,604

1.0

8,062

2.2

1,511

1.4

24

0.3

6,457

2.6

Occupation:

Managerial and professional

123,596

5.5

26,391

7.1

6,364

5.7

269

2.9

19,338

7.9

Technical, sales and 
administrative support

344,402

15.3

67,253

18.2

16,485

14.8

853

9.0

49,227

20.2

Service

414,135

18.4

85,004

23.0

13,512

12.1

574

6.1

70,121

28.7

Farming, forestry and fishing

59,050

2.6

9,979

2.7

4,197

3.8

356

3.8

5,245

2.1

Precision production, craft 
and repair

366,112

16.3

57,254

15.5

27,805

25.0

1,887

20.0

26,577

10.9

Operators, fabricators and 
labourers

925,515

41.1

122,005

33.0

42,074

37.8

5,431

57.6

72,286

29.6

Nature of injuries, illness:

Sprains, strains

959,163

42.6

133,538

36.1

38,636

34.7

5,558

58.9

87,152

35.7

Fractures

136,478

6.1

55,335

15.0

21,052

18.9

1,247

13.2

32,425

13.3

Cuts, lacerations punctures

202,464

9.0

10,431

2.8

2,350

2.1

111

1.2

7,774

3.2

Bruises, contusions

211,179

9.4

66,627

18.0

17,173

15.4

705

7.5

48,062

19.7

Multiple injuries

73,181

3.2

32,281

8.7

11,313

10.2

372

3.9

20,295

8.3

With fractures

13,379

0.6

4,893

1.3

2,554

2.3

26

0.3

2,250

0.9

With sprains

26,969

1.2

15,991

4.3

4,463

4.0

116

1.2

11,309

4.6

Soreness, Pain

127,555

5.7

20,855

5.6

5,614

5.0

529

5.6

14,442

5.9

Back pain

58,385

2.6

8,421

2.3

2,587

2.3

214

2.3

5,520

2.3

All other

411,799

18.3

50,604

13.7

15,012

13.5

897

9.5

33,655

13.8

Part of body affected:

Head

155,504

6.9

13,880

3.8

2,994

2.7

61

0.6

10,705

4.4

Eye

88,329

3.9

314

0.1

50

0.0

11

0.1

237

0.1

Neck

40,704

1.8

3,205

0.9

1,097

1.0

81

0.9

1,996

0.8

Trunk

869,447

38.6

118,369

32.0

33,984

30.5

1,921

20.4

80,796

33.1

Back

615,010

27.3

72,290

19.5

20,325

18.3

1,523

16.1

49,461

20.3

Shoulder

105,881

4.7

16,186

4.4

4,700

4.2

89

0.9

11,154

4.6

Source of injury illness:

Chemicals, chemical 
products

43,411

1.9

22

0.0

16

0.0

Containers

330,285

14.7

7,133

1.9

994

0.9

224

2.4

5,763

2.4

Furniture, fixtures

88,813

3.9

7,338

2.0

881

0.8

104

1.1

6,229

2.6

Machinery

154,083

6.8

4,981

1.3

729

0.7

128

14

4,035

1.7

Parts and materials

249,077

11.1

6,185

1.7

1,016

0.9

255

2.7

4,793

2.0

Worker motion or position

331,994

14.7

Floor, ground surfaces

340,159

15.1

318,176

86.0

98,207

88.3

7,705

81.7

208,765

85.5

Handtools

105,478

4.7

727

0.2

77

0.1

41

0.4

600

0.2

Vehicles

157,360

7.0

9,789

2.6

3,049

2.7

553

5.9

6,084

2.5

Health care patient

99,390

4.4

177

0.0

43

0.0

8

0.1

90

0.0

All other

83,813

3.7

15,584

4.2

6,263

5.6

414

4.4

7,741

3.2

Industry division:

Agriculture, forestry and 
fishing2

44,826

2.0

8,096

2.2

3,636

3.3

301

3.2

3,985

1.6

Mining3

21,090

0.9

3,763

1.0

1,757

1.6

102

1.1

1,874

0.8

Construction

204,769

9.1

41,787

11.3

23,748

21.3

1,821

19.3

15,464

6.3

Manufacturing

583,841

25.9

63,566

17.2

17,693

15.9

2,161

22.9

42,790

17.5

Transportation and public 
utilities3

232,999

10.3

38,452

10.4

14,095

12.7

1,797

19.0

21,757

8.9

Wholesale trade

160,934

7.1

22,677

6.1

8,119

7.3

1,180

12.5

12,859

5.3

Retail trade

408,590

18.1

78,800

21.3

15,945

14.3

1,052

11.1

60,906

24.9

Finance, insurance and 
real estate

60,159

2.7

14,769

4.0

5,353

4.8

112

1.2

9,167

3.8

Services

535,386

23.8

98,201

26.5

20,920

18.8

907

9.6

75,313

30.9

Number of days away from work:

Cases involving 1 day

366,054

16.3

48,550

13.1

12,450

11.2

1,136

12.0

34,319

14.1

Cases involving 2 days

291,760

13.0

42,912

11.6

11,934

10.7

1,153

12.2

29,197

12.0

Cases involving 3-5 days

467,001

20.7

72,156

19.5

20,167

18.1

1,770

18.8

49,329

20.2

Cases involving 6-10 days

301,941

13.4

45,375

12.3

13,240

11.9

1,267

13.4

30,171

12.4

Cases involving 11-20 days

256,319

11.4

44,228

11.9

13,182

11.8

1,072

11.4

29,411

12.0

Cases involving 21-30 days

142,301

6.3

25,884

7.0

8,557

7.7

654

6.9

16,359

6.7

Cases involving 31 or more 
days

427,215

19.0

91,008

24.6

31,737

28.5

2,381

25.2

55,329

22.7

Median days away from work

6 days

 

7 days

 

10 days

 

8 days

 

7 days

 

 1 Days away from work cases include those which result in days away from work with or without restricted work activity.

2 Excludes farms with fewer than 11 employees.

3 Data conforming to OSHA definitions for mining operators in coal, metal, and nonmetal mining and for employers in railroad transportation are provided to BLS by the Mine Safety and Health Administration, U.S. Department of Labor; the Federal Railroad Administration and U.S. Department of Transportation. Independent mining contractors are excluded from the coal, metal, and nonmetal mining industries.

NOTE: Because of rounding and data exclusion of nonclassifiable responses, data may not sum to the totals. Dashes indicate data that do not meet publication guidelines. The survey estimates of occupational injuries and illnesses are based on a scientifically selected sample of employers. The sample used was one of many possible samples, each of which could have produced different estimates. The relative standard error is a measure of the variation in the sample estimates across all possible samples that could have been selected. The percent relative standard errors for the estimates included here range from less than 1 per cent to 58 per cent.
Survey of Occupational Injuries and Illnesses, Bureau of Labor Statistics, US Department of Labor, April 1995.


 

It is clear that data such as these can have an important impact upon development of programmes for work-related accident and disease prevention. Even so, they do not indicate which occupations or industries are the most hazardous, since some very dangerous occupations may have small numbers of workers. Determination of levels of risk associated with particular occupations and industries is explained in the accompanying article “Risk analysis of nonfatal workplace injuries and illnesses”.

 

Back

Thursday, 17 March 2011 18:11

Surveillance in Developing Countries

It is estimated that more than 80% of the world’s population live in the developing countries in Africa, the Middle East, Asia and South and Central America. The developing countries are often financially disadvantaged, and many have largely rural and agricultural economies. However, they are widely different in many ways, with diverse aspirations, political systems and varying stages of industrial growth. The status of health among people in the developing countries is generally lower than in the developed countries, as reflected by higher infant mortality rates and lower life expectancies.

Several factors contribute to the need for occupational safety and health surveillance in developing countries. First, many of these countries are rapidly industrializing. In terms of the size of industrial establishments, many of the new industries are small-scale industries. In such situations, safety and health facilities are often very limited or non-existent. In addition, developing countries are often the recipients of technology transfer from developed countries. Some of the more hazardous industries, which have difficulty in operating in countries with more stringent and better enforced occupational health legislation, may be “exported” to developing countries.

Second, with regard to the workforce, the education level of the workers in developing countries is often lower, and workers may be untrained in safe work practices. Child labour is often more prevalent in developing countries. These groups are relatively more vulnerable to health hazards at work. In addition to these considerations, there is generally a lower pre-existing level of health among workers in developing countries.

These factors would ensure that throughout the world, workers in developing countries are among those who are most vulnerable to and who face the greatest risk from occupational health hazards.

Occupational Health Effects are Different from Those Seen in Developed Countries

It is important to obtain data on health effects for prevention and for prioritization of approaches to solve occupational health problems. However, most of the available morbidity data may not be applicable for developing countries, as they originate from the developed countries.

In developing countries, the nature of the occupational health effects from workplace hazards may be different from those in the developed countries. Overt occupational diseases such as chemical poisonings and the pneumoconioses, which are caused by exposures to high levels of workplace toxins, are still encountered in significant numbers in developing countries, while these problems may have been substantially reduced in the developed countries.

For example, in the case of pesticide poisoning, acute health effects and even deaths from high exposures are a greater immediate concern in developing agricultural countries, as compared to the long-term health effects from low dose exposure to pesticides, which might be a more important issue in the developed countries. In fact, the morbidity burden from acute pesticide poisoning in some developing countries, such as Sri Lanka, may even surpass that of traditional public health problems such as diphtheria, whooping cough and tetanus.

Thus, some surveillance of occupational health morbidity is required from the developing countries. The information would be useful for the assessment of the magnitude of the problem, prioritization of plans to cope with the problems, allocation of resources and for subsequent evaluation of the impact of interventions.

Unfortunately, such surveillance information is often lacking in the developing countries. It should be recognized that surveillance programmes in developed countries may be inappropriate for developing countries, and such systems probably cannot be adopted in their entirety for developing countries because of the various problems which may impede surveillance activities.

Problems of Surveillance in Developing Countries

While the need for surveillance of occupational safety and health problems exists in developing countries, the actual implementation of surveillance is often fraught with difficulties.

The difficulties may arise because of poor control of industrial development, the absence of, or an inadequately developed infrastructure for, occupational health legislation and services, insufficiently trained occupational health professionals, limited health services and poor health reporting systems. Very often the information on the workforce and general population may be lacking or inadequate.

Another major problem is that in many developing countries, occupational health is not accorded a high priority in national development programmes.

Activities in Occupational Health and Safety Surveillance

Surveillance of occupational safety and health may involve activities such as the monitoring of dangerous occurrences at work, work injury and work fatalities. It also includes surveillance of occupational illness and surveillance of the work environment. It is probably easier to collect information on work injury and accidental death at work, since such events are fairly easily defined and recognized. In contrast, surveillance of the health status of the working population, including occupational diseases and the state of the work environment, is more difficult.

The rest of this article will therefore deal mainly with the issue of surveillance of occupational illness. The principles and approaches which are discussed can be applied to the surveillance of work injuries and fatalities, which are also very important causes of morbidity and mortality among workers in developing countries.

Surveillance of workers’ health in developing countries should not be limited only to occupational diseases, but should also be for general diseases of the working population. This is because the main health problems among workers in some developing countries in Africa and Asia may not be occupational, but may include other general diseases such as infectious diseases—for example, tuberculosis or sexually transmitted diseases. The information collected would then be useful for planning and allocation of health care resources for the promotion of health of the working population.

Some Approaches to Overcome the Problems of Surveillance

Which types of occupational health surveillance are appropriate in developing countries? In general, a system with simple mechanisms, employing available and appropriate technology, would be best suited for developing countries. Such a system should also take into account the types of industries and work hazards which are important in the country.

Utilization of existing resources

Such a system may utilize the existing resources such as the primary health care and environmental health services. For example, occupational health surveillance activities can be integrated into the current duties of primary health care personnel, public health inspectors and environmental engineers.

For this to happen, primary health care and public health personnel have first to be trained to recognize illness which may be related to the work, and even to perform simple assessments of unsatisfactory workplaces in terms of occupational safety and health. Such personnel should, of course, receive adequate and appropriate training in order to perform these tasks.

The data on conditions of work and illness arising from work activities can be collated while such persons conduct their routine work in the community. The information collected can be channelled to regional centres, and ultimately to a central agency responsible for the monitoring of conditions of work and occupational health morbidity that is also responsible for acting on these problems.

Registry of factories and work processes

A registry of factories and work processes, as opposed to a disease registry, could be initiated. This registry would obtain information from the registration stage of all factories, including work processes and materials used. The information should be updated periodically when new work processes or materials are introduced. Where, in fact, such registration is required by national legislation, it needs to be enforced in a comprehensive manner.

However, for small-scale industries, such registration is often bypassed. Simple field surveys and assessments of the types of industry and the state of working conditions could provide basic information. The persons who could perform such simple assessments could again be the primary health care and public health personnel.

Where such a registry is in effective operation, there is also a need for periodic update of the data. This could be made compulsory for all registered factories. Alternatively, it may be desirable to request an update from factories in various high-risk industries.

Notification of occupational diseases

Legislation for notification of selected occupational health disorders could be introduced. It would be important to publicize and educate people on this matter before implementation of the law. Questions such as what diseases should be reported, and who should be the persons responsible for notification, should first be resolved. For example, in a developing country like Singapore, physicians who suspect the occupational diseases listed in table 1 have to notify the Ministry of Labour. Such a list has to be tailored to the types of industry in a country, and be revised and updated periodically. Furthermore, the persons responsible for notification should be trained to recognize, or at least to suspect, the occurrence of the diseases.

Table 1. Sample list of notifiable occupational diseases

Aniline poisoning

Industrial dermatitis

Anthrax

Lead poisoning

Arsenical poisoning

Liver angiosarcoma

Asbestosis

Manganese poisoning

Barotrauma

Mercurial poisoning

Beryllium poisoning

Mesothelioma

Byssinosis

Noise-induced deafness

Cadmium poisoning

Occupational asthma

Carbon disulphide poisoning

Phosphorous poisoning

Chrome ulceration

Silicosis

Chronic benzene poisoning

Toxic anaemia

Compressed air illness

Toxic hepatitis

 

Continuous follow-up and enforcement action is needed to ensure the success of such notification systems. Otherwise, gross underreporting would limit their usefulness. For example, occupational asthma was first made notifiable and compensable in Singapore in 1985. An occupational lung disease clinic was also set up. Despite these efforts, a total of only 17 cases of occupational asthma were confirmed. This can be contrasted with the data from Finland, where there were 179 reported cases of occupational asthma in 1984 alone. Finland’s population of 5 million is only about twice that of Singapore. This gross under-reporting of occupational asthma is probably due to the difficulty in diagnosing the condition. Many doctors are unfamiliar with the causes and features of occupational asthma. Hence, even with the implementation of compulsory notification, it is important to continue to educate the health professionals, employers and employees.

When the notification system is initially implemented, a more accurate assessment of the prevalence of the occupational disease can be made. For example, the number of notifications of noise-induced hearing loss in Singapore increased six-fold after statutory medical examinations were introduced for all noise-exposed workers. Subsequently, if the notification is fairly complete and accurate, and if a satisfactory denominator population could be obtained, it may even be possible to estimate the incidence of the condition and its relative risk.

As in many notification and surveillance systems, the important role of notification is to alert the authorities to index cases at the workplace. Further investigations and workplace interventions, if necessary, are required follow-up activities. Otherwise, the efforts of notification would be wasted.

Other sources of information

Hospital and outpatient health information is often underutilized in the surveillance of occupational health problems in a developing country. Hospitals and outpatient clinics can and should be incorporated into the notification system for specific diseases, such as acute work-related poisonings and injuries. The data from these sources would also provide an idea of the common health problems among workers, and can be used for the planning of workplace health promotion activities.

All this information is usually routinely collected, and few extra resources are required to direct the data to the occupational health and safety authorities in a developing country.

Another possible source of information would be the compensation clinics or tribunals. Finally, if the resources are available, some regional occupational medicine referral clinics might also be initiated. These clinics could be staffed by more qualified occupational health professionals, and would investigate any suspected work-related illness.

Information from existing disease registries should also be utilized. In many larger cities of developing countries, cancer registries are in place. Though the occupational history obtained from these registries may not be complete and accurate, it is useful for preliminary monitoring of broad occupational groups. Data from such registries will be even more valuable if registers of workers exposed to specific hazards are available for cross-matching.

The role of data linkage

While this may sound attractive, and has been employed with some success in some developed countries, this approach may not be appropriate or even possible in developing countries at present. This is because the infrastructure required for such a system is often not available in developing countries. For example, disease registries and workplace registers may not be available or, if they exist, may not be computerized and easily linked.

Help from international agencies

International agencies such as the International Labour Organization, the World Health Organization and bodies such as the International Commission on Occupational Health can contribute their experience and expertise in overcoming common problems of occupational health and safety surveillance in a country. In addition, training courses as well as training opportunities for primary care persons may be developed or offered.

Sharing of information from regional countries with similar industries and occupational health problems is also often useful.

Summary

Occupational safety and health services are important in developing countries. This is especially so in view of the rapid industrialization of the economy, the vulnerable work population and the poorly controlled health hazards faced at work.

In the development and delivery of occupational health services in these countries, it is important to have some type of surveillance of occupational ill health. This is necessary for the justification, planning and prioritization of occupational health legislation and services, and the evaluation of the outcome of these measures.

While surveillance systems are in place in the developed countries, such systems may not always be appropriate for developing countries. Surveillance systems in developing countries should take into account the type of industry and hazards which are important in the country. Simple surveillance mechanisms, employing available and appropriate technology, are often the best options for developing countries.

 

Back

Thursday, 17 March 2011 18:09

Occupational Hazard Surveillance

Hazard surveillance is the process of assessing the distribution of, and the secular trends in, use and exposure levels of hazards responsible for disease and injury (Wegman 1992). In a public health context, hazard surveillance identifies work processes or individual workers exposed to high levels of specific hazards in particular industries and job categories. Since hazard surveillance is not directed at disease events, its use in guiding public health intervention generally requires that a clear exposure-outcome relationship has previously been established. Surveillance can then be justified on the assumption that reduction in the exposure will result in reduced disease. Proper use of hazard surveillance data enables timely intervention, permitting the prevention of occupational illness. Its most significant benefit is therefore the elimination of the need to wait for obvious illness or even death to occur before taking measures to protect workers.

There are at least five other advantages of hazard surveillance which complement those provided by disease surveillance. First, identifying hazard events is usually much easier than identifying occupational disease events, particularly for diseases such as cancer that have long latency periods. Second, a focus on hazards (rather than illnesses) has the advantage of directing attention to the exposures which ultimately are to be controlled. For example, surveillance of lung cancer might focus on rates in asbestos workers. However, a sizeable proportion of lung cancer in this population could be due to cigarette smoking, either independently of or interacting with the asbestos exposure, so that large numbers of workers might need to be studied to detect a small number of asbestos-related cancers. On the other hand, surveillance of asbestos exposure could provide information on the levels and patterns of exposure (jobs, processes or industries) where the poorest exposure control exists. Then, even without an actual count of lung cancer cases, efforts to reduce or eliminate exposure would be appropriately implemented.

Third, since not every exposure results in disease, hazard events occur with much higher frequency than disease events, resulting in the opportunity to observe an emerging pattern or change over time more easily than with disease surveillance. Related to this advantage is the opportunity to make greater use of sentinel events. A sentinel hazard can be simply the presence of an exposure (e.g., beryllium), as indicated via direct measurement in the workplace; the presence of an excessive exposure, as indicated via biomarker monitoring (e.g., elevated blood lead levels); or a report of an accident (e.g., a chemical spill).

A fourth advantage of the surveillance of hazards is that data collected for this purpose do not infringe on an individual’s privacy. Confidentiality of medical records is not at risk and the possibility of stigmatizing an individual with a disease label is avoided. This is particularly important in industrial settings where a person’s job may be in jeopardy or a potential compensation claim may affect a physician’s choice of diagnostic options.

Finally, hazard surveillance can take advantage of systems designed for other purposes. Examples of ongoing collection of hazard information which already exists include registries of toxic substance use or hazardous material discharges, registries for specific hazardous substances and information collected by regulatory agencies for use in compliance. In many respects, the practising industrial hygienist is already quite familiar with the surveillance uses of exposure data.

Hazard surveillance data can complement disease surveillance both for research to establish or confirm a hazard-disease association, as well as for public health applications, and the data collected in either instance can be used to determine the need for remediation. Different functions are served by national surveillance data (as might be developed using the US OSHA Integrated Management Information System data on industrial hygiene compliance sample results—see below) in contrast to those served by hazard surveillance data at a plant level, where much more detailed focus and analysis are possible.

National data may be extremely important in targeting inspections for compliance activity or for determining what is the probable distribution of risks that will result in specific demands on medical services for a region. Plant-level hazard surveillance, however, provides the necessary detail for close examination of trends over time. Sometimes a trend occurs independently of changes in controls but rather in response to product changes which would not be evident in regionally grouped data. Both national and plant-level approaches can be useful in determining whether there is a need for planned scientific studies or for worker and management educational programmes.

By combining hazard surveillance data from routine inspections in a wide range of seemingly unrelated industries, it is sometimes possible to identify groups of workers for whom heavy exposure might otherwise be overlooked. For example, analysis of airborne lead concentrations as determined in OSHA compliance inspections for 1979 to 1985 identified 52 industries in which the permissible exposure limit (PEL) was exceeded in more than one-third of inspections (Froines et al. 1990). These industries included primary and secondary smelting, battery manufacture, pigment manufacture and brass/bronze foundries. As these are all industries with historically high lead exposure, excessive exposures indicated poor control of known hazards. However some of these workplaces are quite small, such as secondary lead smelter operations, and individual plant managers or operators may be unlikely to undertake systematic exposure sampling and could thus be unaware of serious lead exposure problems in their own workplaces. In contrast to high levels of ambient lead exposures that might have been expected in these basic lead industries, it was also noted that over one-third of the plants in the survey in which the PELs were exceeded resulted from painting operations in a wide variety of general industry settings. Structural steel painters are known to be at risk for lead exposure, but little attention has been directed to industries that employ painters in small operations painting machinery or machinery parts. These workers are at risk of hazardous exposures, yet they often are not considered to be lead workers because they are in an industry which is not a lead-based industry. In a sense, this survey revealed evidence of a risk that was known but had been forgotten until it was identified by analysis of these surveillance data.

Objectives of Hazard Surveillance

Programmes of hazard surveillance can have a variety of objectives and structures. First, they permit focus on intervention actions and help to evaluate existing programmes and to plan new ones. Careful use of hazard surveillance information can lead to early detection of system failure and call attention to the need for improved controls or repairs before excess exposures or diseases are actually experienced. Data from such efforts can also provide evidence of need for new or revised regulation for a specific hazard. Second, surveillance data can be incorporated into projections of future disease to permit planning of both compliance and medical resource use. Third, using standardized exposure methodologies, workers at various organizational and governmental levels can produce data which permit focus on a nation, a city, an industry, a plant or even a job. With this flexibility, surveillance can be targeted, adjusted as needed, and refined as new information becomes available or as old problems are solved or new ones appear. Finally, hazard surveillance data should prove valuable in planning epidemiological studies by identifying areas where such studies would be most fruitful.

Examples of Hazard Surveillance

Carcinogen Registry—Finland. In 1979 Finland began to require national reporting of the use of 50 different carcinogens in industry. The trends over the first seven years of surveillance were reported in 1988 (Alho, Kauppinen and Sundquist 1988). Over two-thirds of workers exposed to carcinogens were working with only three types of carcinogens: chromates, nickel and inorganic compounds, or asbestos. Hazard surveillance revealed that a surprisingly small number of compounds accounted for most carcinogen exposures, thus greatly improving the focus for efforts at toxic use reduction as well as efforts at exposure controls.

Another important use of the registry was the evaluation of reasons that listings “exited” the system—that is, why use of a carcinogen was reported once but not on subsequent surveys. Twenty per cent of exits were due to continuing but unreported exposure. This led to education for, as well as feedback to, the reporting industries about the value of accurate reporting. Thirty-eight per cent exited because exposure had stopped, and among these over half exited due to substitution by a non-carcinogen. It is possible that the results of the surveillance system reports stimulated the substitution. Most of the remainder of the exits resulted from elimination of exposures by engineering controls, process changes or considerable decrease in use or exposure time. Only 5% of exits resulted from use of personal protective equipment. This example shows how an exposure registry can provide a rich resource for understanding the use of carcinogens and for tracking the change in use over time.

National Occupational Exposure Survey (NOES). The US NIOSH carried out two National Occupational Exposure Surveys (NOES) ten years apart to estimate the number of workers and workplaces potentially exposed to each of a wide variety of hazards. National and state maps were prepared that show the items surveyed, such as the pattern of workplace and worker exposures to formaldehyde (Frazier, Lalich and Pedersen 1983). Superimposing these maps on maps of mortality for specific causes (e.g., nasal sinus cancer) provides the opportunity for simple ecological examinations designed to generate hypotheses which can then be investigated by appropriate epidemiological study.

Changes between the two surveys have also been examined—for example, the proportions of facilities in which there were potential exposures to continuous noise without functioning controls (Seta and Sundin 1984). When examined by industry, little change was seen for general building contractors (92.5% to 88.4%), whereas a striking decrease was seen for chemicals and allied products (88.8% to 38.0%) and for miscellaneous repair services (81.1% to 21.2%). Possible explanations included passage of the Occupational Safety and Health Act, collective bargaining agreements, concerns with legal liability and increased employee awareness.

Inspection (Exposure) Measures (OSHA). The US OSHA has been inspecting workplaces to evaluate the adequacy of exposure controls for over twenty years. For most of that time, the data have been placed in a database, the Integrated Management Information System (OSHA/IMIS). Overall secular trends in selected cases have been examined for 1979 to 1987. For asbestos, there is good evidence for largely successful controls. In contrast, while the number of samples collected for exposures to silica and lead declined over those years, both substances continued to show a substantial number of overexposures. The data also showed that despite reduced numbers of inspections, the proportion of inspections in which exposure limits were exceeded remained essentially constant. Such data could be highly instructive to OSHA when planning compliance strategies for silica and lead.

Another use of the workplace inspection database has been a quantitative examination of silica exposure levels for nine industries and jobs within those industries (Froines, Wegman and Dellenbaugh 1986). Exposure limits were exceeded to various degrees, from 14% (aluminium foundries) to 73% (potteries). Within the potteries, specific jobs were examined and the proportion where exposure limits were exceeded ranged from 0% (labourers) to 69% (sliphouse workers). The degree to which samples exceeded the exposure limit varied by job. For sliphouse workers excess exposures were, on average, twice the exposure limit, while slip/glaze sprayers had average excess exposures of over eight times the limit. This level of detail should prove valuable to management and workers employed in potteries as well as to government agencies responsible for regulating occupational exposures.

Summary

This article has identified the purpose of hazard surveillance, described its benefits and some of its limitations and offered several examples in which it has provided useful public health information. However, hazard surveillance should not replace disease surveillance for noninfectious diseases. In 1977 a NIOSH task force emphasized the relative interdependence of the two major types of surveillance, stating:

The surveillance of hazards and diseases cannot proceed in isolation from each other. The successful characterization of the hazards associated with different industries or occupations, in conjunction with toxicological and medical information relating to the hazards, can suggest industries or occupational groups appropriate for epidemiological surveillance (Craft et al. 1977).

 

Back

Occupational disease and injury surveillance entails the systematic monitoring of health events in working populations in order to prevent and control occupational hazards and their associated diseases and injuries. Occupational disease and injury surveillance has four essential components (Baker, Melius and Millar 1988; Baker 1986).

  1. Gather information on cases of occupational diseases and injuries.
  2. Distil and analyse the data.
  3. Disseminate organized data to necessary parties, including workers, unions, employers, governmental agencies and the public.
  4. Intervene on the basis of data to alter the factors that produced these health events.

Surveillance in occupational health has been more concisely described as counting, evaluating and acting (Landrigan 1989).

Surveillance commonly refers to two broad sets of activities in occupational health. Public health surveillance refers to activities undertaken by federal, state or local governments within their respective jurisdictions to monitor and to follow up on occupational diseases and injuries. This type of surveillance is based on a population, that is, the working public. The recorded events are suspected or established diagnoses of occupational illness and injury. This article will examine these activities.

Medical surveillance refers to the application of medical tests and procedures to individual workers who may be at risk for occupational morbidity, to determine whether an occupational disorder may be present. Medical surveillance is generally broad in scope and represents the first step in ascertaining the presence of a work-related problem. If an individual or a population is exposed to a toxin with known effects, and if the tests and procedures are highly targeted to detect the likely presence of one or more effects in these persons, then this surveillance activity is more aptly described as medical screening (Halperin and Frazier 1985). A medical surveillance programme applies tests and procedures on a group of workers with common exposures for the purpose of identifying individuals who may have occupational illnesses and for the purpose of detecting patterns of illness which may be produced by occupational exposures among the programme participants. Such a programme is usually undertaken under the auspices of the individual’s employer or union.

Functions of Occupational Health Surveillance

Foremost among the purposes of occupational health surveillance is to identify the incidence and prevalence of known occupational diseases and injuries. Gathering descriptive epidemiological data on the incidence and prevalence of these diseases on an accurate and comprehensive basis is an essential prerequisite for establishing a rational approach to the control of occupational disease and injury. Assessment of the nature, magnitude and distribution of occupational disease and injury in any geographic area requires a sound epidemiological database. It is only through an epidemiological assessment of the dimensions of occupational disease that its importance relative to other public health problems, its claim for resources and the urgency of legal standard setting can be reasonably evaluated. Second, the collection of incidence and prevalence data allows analysis of trends of occupational disease and injury among different groups, at different places and during different time periods. Detecting such trends is useful for determining control and research priorities and strategies, and for evaluating the effectiveness of any interventions undertaken (Baker, Melius and Millar 1988).

A second broad function of occupational health surveillance is to identify individual cases of occupational disease and injury in order to find and evaluate other individuals from the same workplaces who may be at risk for similar disease and injury. Also, this process permits the initiation of control activities to ameliorate the hazardous conditions associated with causation of the index case (Baker, Melius and Millar 1988; Baker, Honchar and Fine 1989).An index case of occupational disease or injury is defined as the first ill or injured individual from a given workplace to receive medical care and thereby to draw attention to the existence of a workplace hazard and an additional workplace population at risk. A further purpose of case identification may be to assure that the affected individual receives appropriate clinical follow-up, an important consideration in view of the scarcity of clinical occupational medicine specialists (Markowitz et al. 1989; Castorino and Rosenstock 1992).

Finally, occupational health surveillance is an important means of discovering new associations between occupational agents and accompanying diseases, since the potential toxicity of most chemicals used in the workplace is not known. Discovery of rare diseases, patterns of common diseases or suspicious exposure-disease associations through surveillance activities in the workplace can provide vital leads for a more conclusive scientific evaluation of the problem and possible verification of new occupational diseases.

Obstacles to the Recognition of Occupational Diseases

Several important factors undermine the ability of occupational disease surveillance and reporting systems to fulfil the functions cited above. First, recognition of the underlying cause or causes of any illness is the sine qua non for recording and reporting occupational diseases. However, in a traditional medical model that emphasizes symptomatic and curative care, identifying and eliminating the underlying cause of illness may not be a priority. Furthermore, health care providers are often not adequately trained to suspect work as a cause of disease (Rosenstock 1981) and do not routinely obtain histories of occupational exposure from their patients (Institute of Medicine 1988). This should not be surprising, given that in the United States, the average medical student receives only six hours of training in occupational medicine during the four years of medical school (Burstein and Levy 1994).

Certain features characteristic of occupational disease exacerbate the difficulty of recognizing occupational diseases. With few exceptions—most notably, angiosarcoma of the liver, malignant mesothelioma and the pneumoconioses—most diseases that can be caused by occupational exposures also have non-occupational causes. This non-specificity renders difficult the determination of the occupational contribution to disease occurrence. Indeed, the interaction of occupational exposures with other risk factors may greatly increase the risk of disease, as occurs with asbestos exposure and cigarette smoking. For chronic occupational diseases such as cancer and chronic respiratory disease, there usually exists a long period of latency between onset of occupational exposure and presentation of clinical disease. For example, malignant mesothelioma typically has a latency of 35 years or more. A worker so affected may well have retired, further diminishing a physician’s suspicion of possible occupational aetiologies.

Another cause of the widespread under-recognition of occupational disease is that the majority of chemicals in commerce have never been evaluated with regard to their potential toxicity. A study by the National Research Council in the United States in the 1980s found no information available on the toxicity of approximately 80% of the 60,000 chemical substances in commercial use. Even for those groups of substances that are most closely regulated and about which the most information is available—drugs and food additives—reasonably complete information on possibly untoward effects is available for only a minority of agents (NRC 1984).

Workers may have a limited ability to provide an accurate report of their toxic exposures. Despite some improvement in countries such as the United States in the 1980s, many workers are not informed of the hazardous nature of the materials with which they work. Even when such information is provided, recalling the extent of exposure to multiple agents in a variety of jobs over a working career may be difficult. As a result, even health care providers who are motivated to obtain occupational information from their patients may not be able to do so.

Employers may be an excellent source of information regarding occupational exposures and the occurrence of work-related diseases. However, many employers do not have the expertise to assess the extent of exposure in the workplace or to determine whether an illness is work related. In addition, financial disincentives to finding that a disease is occupational in origin may discourage employers from using such information appropriately. The potential conflict of interest between the financial health of the employer and the physical and mental health of the worker represents a major obstacle to improving surveillance of occupational disease.

Registries and other Data Sources Specific for Occupational Diseases

International registries

International registries for occupational diseases are an exciting development in occupational health. The obvious benefit of these registries is the ability to conduct large studies, which would allow determination of the risk of rare diseases. Two such registries for occupational diseases were initiated during the 1980s.

The International Agency for Research on Cancer (IARC) established the International Register of Persons Exposed to Phenoxy Herbicides and Contaminants in 1984 (IARC 1990). As of 1990, it had enrolled 18,972 workers from 19 cohorts in ten countries. By definition all enrolees worked in industries involving phenoxy herbicides and/or chlorophenols, principally in manufacturing/formulating industries or as applicators. Exposure estimates have been made for participating cohorts (Kauppinen et al. 1993), but analyses of cancer incidence and mortality have not yet been published.

An international registry of cases of angiosarcoma of the liver (ASL) is being coordinated by Bennett of ICI Chemicals and Polymers Limited in England. Occupational exposure to vinyl chloride is the only known cause of angiosarcoma of the liver. Cases are reported by a voluntary group of scientists from companies producing vinyl chloride, governmental agencies and universities. As of 1990, 157 cases of ASL with dates of diagnosis between 1951 and 1990 were reported to the registry from 11 countries or regions. Table 1 also shows that most of the recorded cases were reported from countries where facilities started polyvinyl chloride manufacture before 1950. The registry has recorded six clusters of ten or more cases of ASL at facilities in North America and Europe (Bennett 1990).

Table 1. Number of cases of angiosarcoma of the liver in the world register by country and year of first production of vinyl chloride

Country/Region

Number of PVC
producing
facilities

Year PVC production initiated

Number of cases
of angiosarcoma
of the liver

USA

50

(1939?)

39

Canada

5

(1943)

13

West Germany

10

(1931)

37

France

8

(1939)

28

United Kingdom

7

(1940)

16

Other Western Europe

28

(1938)

15

Eastern Europe

23

(pre-1939)

6

Japan

36

(1950)

3

Central and
South America

22

(1953)

0

Australia

3

(1950s)

0

Middle East

1

(1987)

0

Total

193

 

157

Source: Bennett, B. World Register of Cases of Angiosarcoma of the Liver (ASL)
due to Vinyl Chloride Monomer
, January 1, 1990.

Governmental surveys

Employers are sometimes legally required to record occupational injuries and illnesses that occur in their facilities. Like other workplace-based information, such as numbers of employees, wages and overtime, injury and illness data may be systematically collected by governmental agencies for the purpose of surveillance of work-related health outcomes.

In the United States, the Bureau of Labor Statistics (BLS) of the US Department of Labor has conducted the Annual Survey of Occupational Injuries and Illnesses (BLS Annual Survey) since 1972 as required by the Occupational Safety and Health Act (BLS 1993b). The goal of the survey is to obtain the numbers and the rates of illnesses and injuries recorded by private employers as being occupational in origin (BLS 1986). The BLS Annual Survey excludes employees of farms with fewer than 11 employees, the self-employed and employees of the federal, state and local governments. For the most recent year available, 1992, the survey reflects questionnaire data obtained from a stratified random sample of approximately 250,000 establishments in the private sector in the United States (BLS 1994).

The BLS survey questionnaire completed by the employer is derived from a written record of occupational injuries and illnesses which employers are required to maintain by the Occupational Safety and Health Administration (OSHA 200 Log). Although OSHA mandates that the employer keep the 200 Log for examination by an OSHA inspector upon request, it does not require that employers routinely report the log’s contents to OSHA, except for the sample of employers included in the BLS Annual Survey (BLS 1986).

Some well-recognized weaknesses severely limit the ability of the BLS survey to provide a full and accurate count of occupational illnesses in the United States (Pollack and Keimig 1987). Data are employer derived. Any illness that the employee does not report to the employer as being work related will not be reported by the employer on the annual survey. Among active workers, such a failure to report may be due to fear of consequences to the employee. Another major obstacle to reporting is the failure of the employee’s physician to diagnose illness as being work related, especially for chronic diseases. Occupational diseases occurring among retired workers are not subject to the BLS reporting requirement. Indeed, it is unlikely that the employer would be aware of the onset of a work-related illness in a retiree. Since many cases of chronic occupational illnesses with long latency, including cancer and lung disease, are likely to have their onset following retirement, a large proportion of such cases would not be included in the data collected by the BLS. These limitations were recognized by BLS in a recent report on its annual survey (BLS 1993a). In response to recommendations by the National Academy of Sciences, the BLS re-designed and implemented a new annual survey in 1992.

According to the 1992 BLS Annual Survey, there were 457,400 occupational illnesses in private industry in the United States (BLS 1994). This represented a 24% increase, or 89,100 cases, over the 368,300 illnesses recorded in the 1991 BLS Annual Survey. The incidence of new occupational illnesses was 60.0 per 10,000 workers in 1992.

Disorders associated with repeated trauma, such as carpal tunnel syndrome, tendonitis of the wrist and elbow and hearing loss, dominate the occupational illnesses recorded in the BLS Annual survey and have done so since 1987 (table 2). In 1992, they accounted for 62% of all illness cases recorded on the annual survey. Other important categories of disease were skin disorders, pulmonary diseases and disorders associated with physical trauma.

Table 2. Number of new cases of occupational illness by category of illness-US Bureau of Labor Statistics Annual Survey, 1986 versus 1992.

Category of Illness

1986

1992

% Change 1986–1992

Skin diseases

41,900

62,900

+ 50.1%

Dust diseases of the lungs

3,200

2,800

– 12.5%

Respiratory conditions due to toxic agents

12,300

23,500

+ 91.1%

Poisonings

4,300

7,000

+ 62.8%

Disorders due to physical agents

9,200

22,200

+141.3%

Disorders associated with repeated trauma

45,500

281,800

+519.3%

All other occupational illnesses

20,400

57,300

+180.9%

Total

136,900

457,400

+234.4%

Total excluding repeated trauma

91,300

175,600

+ 92.3%

Average annual employment in the private sector, United States

83,291,200

90,459,600

+ 8.7%

Sources: Occupational Injuries and Illnesses in the United States by Industry, 1991.
US Department of Labor, Bureau of Labor Statistics, May 1993. Unpublished data,
US Department of Labor, Bureau of Labor Statistics, December, 1994.

Although disorders associated with repeated trauma clearly account for the largest proportion of the increase in cases of occupational illness, there was also a 50% increase in the recorded incidence in occupational illnesses other than those due to repeated trauma in the six years between 1986 and 1992, during which employment in the United States rose by just 8.7%.

These increases in the numbers and rates of occupational diseases recorded by employers and reported to the BLS in recent years in the United States are remarkable. The rapid change in the recording of occupational illnesses in the United States is due to a change in the underlying occurrence of disease and to a change in the recognition and reporting of these conditions. By comparison, during the same time period, 1986 to 1991, the rate of occupational injuries per 100 full-time workers recorded by the BLS went from 7.7 in 1986 to 7.9 in 1991, a mere 2.6% increase. The number of recorded fatalities in the workplace has likewise not increased dramatically in the first half of the 1990s.

Employer-based surveillance

Apart from the BLS survey, many US employers conduct medical surveillance of their workforces and thereby generate a vast amount of medical information that is relevant to the surveillance of occupational diseases. These surveillance programmes are undertaken for numerous purposes: to comply with OSHA regulations; to maintain a healthy workforce through the detection and treatment of non-occupational disorders; to ensure that the employee is fit to perform the tasks of the job, including the need to wear a respirator; and to conduct epidemiological surveillance to uncover patterns of exposure and disease. These activities utilize considerable resources and could potentially make a major contribution to the public health surveillance of occupational diseases. However, since these data are non-uniform, of uncertain quality and largely inaccessible outside the companies in which they are collected, their exploitation in occupational health surveillance has been realized on only a limited basis (Baker, Melius and Millar 1988).

OSHA also requires that employers perform selected medical surveillance tests for workers exposed to a limited number of toxic agents. Additionally, for fourteen well-recognized bladder and lung carcinogens, OSHA requires a physical examination and occupational and medical histories. The data collected under these OSHA provisions are not routinely reported to governmental agencies or other centralized data banks and are not accessible for the purposes of occupational disease reporting systems.

Surveillance of public employees

Occupational disease reporting systems may differ for public versus private employees. For example, in the United States, the annual survey of occupational illnesses and injuries conducted by the federal Department of Labor (BLS Annual Survey) excludes public employees. Such workers are, however, an important part of the workforce, representing approximately 17% (18.4 million workers) of the total workforce in 1991. Over three-fourths of these workers are employed by state and local governments.

In the United States, data on occupational illnesses among federal employees are collected by the Federal Occupational Workers’ Compensation Program. In 1993, there were 15,500 occupational disease awards to federal workers, yielding a rate of 51.7 cases of occupational illnesses per 10,000 full-time workers (Slighter 1994). At the state and local levels, the rates and numbers of illnesses due to occupation are available for selected states. A recent study of state and local employees in New Jersey, a sizeable industrial state, documented 1,700 occupational illnesses among state and local employees in 1990, yielding an incidence of 50 per 10,000 public-sector workers (Roche 1993). Notably, the rates of occupational disease among federal and non-federal public workers are remarkably congruent with the rates of such illness among private sector workers as recorded in the BLS Annual Survey. The distribution of illness by type differs for public versus private workers, a consequence of the different type of work that each sector performs.

Workers’ compensation reports

Workers’ compensation systems provide an intuitively appealing surveillance tool in occupational health, because the determination of work-relatedness of disease in such cases has presumably undergone expert review. Health conditions that are acute and easily recognized in origin are frequently recorded by workers’ compensation systems. Examples include poisonings, acute inhalation of respiratory toxins and dermatitis.

Unfortunately, the use of workers’ compensation records as a credible source for surveillance data is subject to severe limitations, including lack of standardization of eligibility requirements, deficiency of standard case definitions, disincentives to workers and employers to file claims, the lack of physician recognition of chronic occupational diseases with long latent periods and the usual gap of several years between initial filing and resolution of a claim. The net effect of these limitations is that there is significant under-recording of occupational disease by workers’ compensation systems.

Thus, in a study by Selikoff in the early 1980s, less than one-third of US insulators who were disabled by asbestos-related diseases, including asbestosis and cancer, had even filed for workers’ compensation benefits, and many fewer were successful in their claims (Selikoff 1982). Similarly, a US Department of Labor study of workers who reported disability from occupational disease found that less than 5% of these workers received workers’ compensation benefits (USDOL 1980). A more recent study in the state of New York found that the number of people admitted to hospitals for pneumoconioses vastly outnumbered the people who were newly awarded workers’ compensation benefits during a similar time period (Markowitz et al. 1989). Since workers’ compensation systems record simple health events such as dermatitis and musculoskeletal injuries much more readily than complex diseases of long latency, use of such data leads to a skewed picture of the true incidence and distribution of occupational diseases.

Laboratory reports

Clinical laboratories can be an excellent source of information on excessive levels of selected toxins in body fluids. Advantages of this source are timely reporting, quality-control programmes already in place and the leverage for compliance provided by the licensing of such laboratories by governmental agencies. In the United States, numerous states require that clinical laboratories report the results of selected categories of specimens to the state health departments. Occupational agents subject to this reporting requirement are lead, arsenic, cadmium and mercury as well as substances reflecting pesticide exposure (Markowitz 1992).

In the United States, the National Institute for Occupational Safety and Health (NIOSH) began to assemble the results of adult blood lead testing into the Adult Blood Lead Epidemiology and Surveillance programme in 1992 (Chowdhury, Fowler and Mycroft 1994). By the end of 1993, 20 states, representing 60% of the US population, were reporting elevated blood lead levels to NIOSH, and an additional 10 states were developing the capacity to collect and report blood lead data. In 1993, there were 11,240 adults with blood lead levels that equalled or exceeded 25 micrograms per decilitre of blood in the 20 reporting states. The vast majority of these individuals with elevated blood lead levels (over 90%) were exposed to lead at the workplace. Over one-quarter (3,199) of these individuals had blood leads greater than or equal to 40 ug/dl, the threshold at which the US Occupational Safety and Health Administration requires actions to protect workers from occupational lead exposure.

Reporting of elevated levels of toxins to the state health department may be followed by a public health investigation. Confidential follow-up interviews with affected individuals allows timely identification of the workplaces where exposure occurred, categorization of the case by occupation and industry, estimation of the number of other workers at the workplace potentially exposed to lead and assurance of medical follow-up (Baser and Marion 1990). Worksite visits are followed by recommendations for voluntary actions to reduce exposure or may lead to reporting to authorities with legal enforcement powers.

Physicians’ reports

In an attempt to replicate the strategy successfully utilized for the monitoring and control of infectious diseases, an increasing number of states in the United States require physicians to report one or more occupational diseases (Freund, Seligman and Chorba 1989). As of 1988, 32 states required reporting of occupational diseases, though these included ten states where only one occupational disease is reportable, usually lead or pesticide poisoning. In other states, such as Alaska and Maryland, all occupational diseases are reportable. In most states, reported cases are used only to count the number of people in the state affected by the disease. In only one-third of the states with reportable disease requirements does a report of a case of occupational disease lead to follow-up activities, such as workplace inspection (Muldoon, Wintermeyer and Eure 1987).

Despite the evidence of increased recent interest, physician reporting of occupational diseases to appropriate state governmental authorities is widely acknowledged to be inadequate (Pollack and Keimig 1987; Wegman and Froines 1985). Even in California, where a system for physician reporting has been in place for a number of years (Doctor’s First Report of Occupational Illness and Injury) and recorded nearly 50,000 occupational illnesses in 1988, physician compliance with reporting is regarded as incomplete (BLS 1989).

A promising innovation in occupational health surveillance in the United States is the emergence of the concept of the sentinel provider, part of an initiative undertaken by NIOSH called Sentinel Event Notification System for Occupational Risks (SENSOR). A sentinel provider is a physician or other health care provider or facility that is likely to provide care for workers with occupational disorders due to the provider’s specialty or geographic location.

Since sentinel providers represent a small subset of all health care providers, health departments can feasibly organize an active occupational disease reporting system by performing outreach, offering education and providing timely feedback to sentinel providers. In a recent report from three states participating in the SENSOR programme, physician reports of occupational asthma increased sharply after the state health departments developed concerted educational and outreach programmes to identify and recruit sentinel providers (Matte, Hoffman and Rosenman 1990).

Specialized occupational health clinical facilities

A newly emergent resource for occupational health surveillance has been the development of occupational health clinical centres that are independent of the workplace and that specialize in the diagnosis and treatment of occupational disease. Several dozen such facilities currently exist in the United States. These clinical centres can play several roles in enhancing occupational health surveillance (Welch 1989). First, the clinics can play a primary role in case-finding—that is, identifying occupational sentinel health events—since they represent a unique organizational source of expertise in clinical occupational medicine. Second, the occupational health clinical centres can serve as a laboratory for the development and refinement of surveillance case definitions for occupational disease. Third, the occupational health clinics can serve as a primary clinical referral resource for the diagnosis and evaluation of workers who are employed at a worksite where an index case of occupational disease has been identified.

Occupational health clinics have become organized into a national association in the United States (the Association of Occupational and Environmental Clinics) to enhance their visibility and to collaborate on research and clinical investigations (Welch 1989). In some states, such as New York, a statewide network of clinical centres has been organized by the state health department and receives stable funding from a surcharge on workers’ compensation premiums (Markowitz et al. 1989). The clinical centres in New York State have collaborated in the development of information systems, clinical protocols and professional education and are beginning to generate substantial data on the numbers of cases of occupational disease in the state.

Use of Vital Statistics and Other General Health Data

Death certificates

The death certificate is a potentially very useful instrument for occupational disease surveillance in many countries in the world. Most countries have death registries. Uniformity and comparability is promoted by the common use of the International Classification of Diseases to identify cause of death. Furthermore, many jurisdictions include information on death certificates concerning the occupation and industry of the deceased. A major limitation in the use of death certificates for occupational disease surveillance is the lack of unique relationships between occupational exposures and specific causes of death.

The use of mortality data for occupational disease surveillance is most salient for diseases that are uniquely caused by occupational exposures. These include the pneumoconioses and one type of cancer, malignant mesothelioma of the pleura. Table 3 shows the numbers of deaths attributed to these diagnoses as the underlying cause of death and as one of multiple causes of death listed on the death certificate in the United States. The underlying cause of death is considered the principal cause for death, while the listing of multiple causes includes all conditions considered important in contributing to death.

Table 3. Deaths due to pneumoconiosis and malignant mesothelioma of the pleura. Underlying cause and multiple causes, United States, 1990 and 1991

ICD-9 Code

Cause of death

Numbers of deaths

 

Underlying cause 1991

Multiple causes 1990

500

Coal workers’ pneumoconiosis

693

1,990

501

Asbestosis

269

948

502

Silicosis

153

308

503-505

Other pneumoconioses

122

450

 

Sub-total

1,237

3,696

163.0, 163.1, and 163.9

Malignant mesothelioma pleura

452

553

 

Total

1,689

4,249

Source: United States National Center for Health Statistics.

In 1991, there were 1,237 deaths due to the dust diseases of the lung as the underlying cause, including 693 deaths due to coal workers pneumoconioses and 269 deaths due to asbestosis. For malignant mesothelioma, there was a total of 452 deaths due to pleural mesothelioma. It is not possible to identify the number of deaths due to malignant mesothelioma of the peritoneum, also caused by occupational exposure to asbestos, since International Classification of Disease codes are not specific for malignant mesothelioma of this site.

Table 3 also shows the numbers of deaths in the United States in 1990 due to pneumoconioses and malignant mesothelioma of the pleura when they appear as one of multiple causes of death on the death certificate. For the pneumoconioses, the total where they appear as one of multiple causes is important, since the pneumoconioses often co-exist with other chronic lung diseases.

An important issue is the extent to which pneumoconioses may be under-diagnosed and, therefore, missing from death certificates. The most extensive analysis of the under-diagnosis of a pneumoconiosis has been performed among insulators in the United States and Canada by Selikoff and colleagues (Selikoff, Hammond and Seidman 1979; Selikoff and Seidman 1991). Between 1977 and 1986, there were 123 insulator deaths ascribed to asbestosis on the death certificates. When investigators reviewed medical records, chest radiographs and tissue pathology where available, they ascribed 259 of insulator deaths occurring in these years to asbestosis. Over one-half of pneumoconiosis deaths were, thus, missed in this group well-known to have heavy asbestos exposure. Unfortunately, there are not a sufficient number of other studies of the under-diagnosis of pneumoconioses on death certificates to allow a reliable correction of mortality statistics.

Deaths due to causes that are not specific to occupational exposures have also been used as part of occupational disease surveillance when occupation or industry of decedents is recorded on the death certificates. Analysis of these data in a specified geographical area during a selected time period can yield rates and ratios of disease by cause for different occupations and industries. The role of non-occupational factors in the deaths examined cannot be defined by this approach. However, differences in rates of disease in different occupations and industries suggest that occupational factors may be important and provide leads for more detailed studies. Other advantages of this approach include the ability to study occupations that are usually distributed among many workplaces (e.g., cooks or dry cleaner workers), the use of routinely collected data, a large sample size, relatively low expense and an important health outcome (Baker, Melius and Millar 1988; Dubrow, Sestito and Lalich 1987; Melius, Sestito and Seligman 1989).

Such occupational mortality studies have been published over the past several decades in Canada (Gallagher et al. 1989), Great Britain (Registrar General 1986), and the United States (Guralnick 1962, 1963a and 1963b). In recent years, Milham utilized this approach to examine the occupational distribution of all men who died between 1950 and 1979 in the state of Washington in the United States. He compared the proportion of all deaths due to any specific cause for one occupational group with the relevant proportion for all occupations. Proportional mortality ratios are thereby obtained (Milham 1983). As an example of the yield of this approach, Milham noted that 10 of 11 occupations with probable exposure to electrical and magnetic fields showed an elevation in the proportional mortality ratio for leukaemia (Milham 1982). This was one of the first studies of the relationship between occupational exposure to electro-magnetic radiation and cancer and has been followed by numerous studies that have corroborated the original finding (Pearce et al. 1985; McDowell 1983; Linet, Malker and McLaughlin 1988).

As a result of a cooperative effort between NIOSH, the National Cancer Institute, and the National Center for Health Statistics during the 1980s, analyses of the mortality patterns by occupation and industry between 1984 and 1988 in 24 states in the United States have recently been published (Robinson et al. 1995). These studies evaluated 1.7 million deaths. They confirmed several well-known exposure-disease relationships and reported new associations between selected occupations and specific causes of death. The authors emphasize that occupational mortality studies may be useful to develop new leads for further study, to evaluate results of other studies and to identify opportunities for health promotion.

More recently, Figgs and colleagues at the US National Cancer Institute used this 24-state occupational mortality database to examine occupational associations with non-Hodgkin’s lymphoma (NHL) (Figgs, Dosemeci and Blair 1995). A case-control analysis involving approximately 24,000 NHL deaths occurring between 1984 and 1989 confirmed previously demonstrated excess risks of NHL among farmers, mechanics, welders, repairmen, machine operators and a number of white-collar occupations.

Hospital discharge data

Diagnoses of hospitalized patients represent an excellent source of data for the surveillance of occupational diseases. Recent studies in several states in the United States show that hospital discharge data can be more sensitive than workers’ compensation records and vital statistics data in detecting cases of diseases that are specific to occupational settings, such as the pneumoconioses (Markowitz et al. 1989; Rosenman 1988). In New York State, for example, an annual average of 1,049 people were hospitalized for pneumoconioses in the mid-1980s, compared to 193 newly awarded workers’ compensation cases and 95 recorded deaths from these diseases each year during a similar time interval (Markowitz et al. 1989).

In addition to providing a more accurate count of the number of people ill with selected serious occupational diseases, hospital discharge data can be usefully followed up to detect and to alter workplace conditions that caused the disease. Thus, Rosenman evaluated workplaces in New Jersey where individuals who were hospitalized for silicosis had previously worked and found that the majority of these workplaces had never performed air sampling for silica, had never been inspected by the federal regulatory authority (OSHA) and did not perform medical surveillance for the detection of silicosis (Rosenman 1988).

Advantages of using hospital discharge data for the surveillance of occupational disease are their availability, low cost, relative sensitivity to serious illness and reasonable accuracy. Important disadvantages include the lack of information on occupation and industry and uncertain quality control (Melius, Sestito and Seligman 1989; Rosenman 1988). In addition, only individuals with disease sufficiently severe to require hospitalization will be included in the database and, therefore, cannot reflect the full spectrum of morbidity associated with occupational diseases. Nonetheless, it is likely that hospital discharge data will be increasingly used in occupational health surveillance in future years.

National surveys

Special surveillance surveys undertaken on a national or regional basis can be the source of information more detailed than can be obtained through use of routine vital records. In the United States, the National Center for Health Statistics (NCHS) conducts two periodic national health surveys relevant to occupational health surveillance: the National Health Interview Survey (NHIS) and the National Health and Nutrition Examination Survey (NHANES). The National Health Interview Survey is a national household survey designed to obtain estimates of the prevalence of health conditions from a representative sample of households reflecting the civilian non-institutionalized population of the United States (USDHHS 1980). A chief limitation of this survey is its reliance on self-reporting of health conditions. Occupational and industrial data on participating individuals have been used in the past decade for evaluating rates of disability by occupation and industry (USDHHS 1980), assessing the prevalence of cigarette smoking by occupation (Brackbill, Frazier and Shilling 1988) and recording workers’ views about the occupational risks that they face (Shilling and Brackbill 1987).

With the assistance of NIOSH, an Occupational Health Supplement (NHIS-OHS) was included in 1988 in order to obtain population-based estimates of the prevalence of selected conditions that may be associated with work (USDHHS 1993). Approximately 50,000 households were sampled in 1988, and 27,408 currently employed individuals were interviewed. Among the health conditions addressed by the NHIS-OHS are work-related injuries, dermatologic conditions, cumulative trauma disorders, eye, nose and throat irritation, hearing loss and low-back pain.

In the first completed analysis from the NHIS-OHS, Tanaka and colleagues from NIOSH estimated that the national prevalence of work-related carpal tunnel syndrome in 1988 was 356,000 cases (Tanaka et al. 1995). Of the estimated 675,000 people with prolonged hand pain and medically diagnosed carpal tunnel syndrome, over 50% reported that their health care provider had stated that their wrist condition was caused by workplace activities. This estimate does not include workers who had not worked in the 12 months prior to the survey and who may have been disabled due to work-related carpal tunnel syndrome.

In contrast to the NHIS, the NHANES directly assesses the health of a probability sample of 30,000 to 40,000 individuals in the United States by performing physical examinations and laboratory tests in addition to collecting questionnaire information. The NHANES was conducted twice in the 1970s and most recently in 1988. The NHANES II, which was conducted in the late 1970s, collected limited information on indicators of exposure to lead and selected pesticides. Initiated in 1988, the NHANES III collected additional data on occupational exposures and disease, especially concerning respiratory and neurologic disease of occupational origin (USDHHS 1994).

Summary

Occupational disease surveillance and reporting systems have significantly improved since the mid-1980s. Recording of illnesses is best for diseases unique or virtually unique to occupational causes, such as the pneumoconioses and malignant mesothelioma. Identification and reporting of other occupational diseases depends upon the ability to match occupational exposures with health outcomes. Many data sources enable occupational disease surveillance, though all have important shortcomings with regard to quality, comprehensiveness and accuracy. Important obstacles to improving occupational disease reporting include the lack of interest in prevention in health care, the inadequate training of health care practitioners in occupational health and the inherent conflicts between employers and workers in the recognition of work-related disease. Despite these factors, gains in occupational disease reporting and surveillance are likely to continue in the future.

 

Back

Thursday, 17 March 2011 16:43

Respiratory Protection

In some industries, air contaminated with potentially harmful dusts, fumes, mists, vapours or gases may cause harm to the workers. The control of exposure to these materials is important to decrease the risk of occupational diseases caused by breathing the contaminated air. The best method to control exposure is to minimize workplace contamination. This can be accomplished by using engineering control measures (e.g., by enclosure or confinement of the operation, by general and local ventilation and substitution of less toxic materials). When effective engineering controls are not feasible, or while they are being implemented or evaluated, respirators can be used to protect the health of the worker. For respirators to work as anticipated, an appropriate and well-planned respirator programme is necessary.

Respiratory Hazards

Hazards to the respiratory system can be in the form of air contaminants or due to a lack of sufficient oxygen. The particulates, gases or vapours that constitute air contaminants may be associated with different activities (see table 1).

Table 1. Material hazards associated with particular activities

Type of hazard

Typical sources or activities

Examples

Dusts

Sewing, grinding, sanding, chipping, sand blasting

Wood dust, coal, silica dust

Fumes

Welding, brazing, smelting

Lead, zinc, iron oxide fumes

Mists

Spray painting, metal plating, machining

Paint mists, oil mists

Fibers

Insulation, friction products

Asbestos, fiber glass

Gases

Welding, combustion engines, water treatment

Ozone, carbon dioxide, carbon monoxide, chlorine

Vapours

Degreasing, painting, cleaning products

Methylene chloride, toluene, mineral spirits

 

Oxygen is a normal component of the environment that is necessary to sustain life. Physiologically speaking, oxygen deficiency is a reduction in the availability of oxygen to the body’s tissues. It may be caused by the reduction in the percentage of oxygen in the air or by the reduction in the partial pressure of oxygen. (The partial pressure of a gas equals the fractional concentration of the gas in question times the total atmospheric pressure.) The most common form of oxygen deficiency in working environments occurs when the percentage of oxygen is reduced because it is displaced by another gas in a confined space.

Types of Respirators

Respirators are categorized by the type of cover offered for the respiratory system (inlet covering) and by the mechanism used to protect the wearer from the contaminant or from oxygen deficiency. The mechanism is either air purification or supplied air.

Inlet coverings

The “inlets” to the respiratory system are the nose and the mouth. For a respirator to work, these must be sealed by a cover that will in some way isolate the person’s respiratory system from hazards in the respirable environment while simultaneously permitting the intake of sufficient oxygen. The types of coverings that are used may be either tight or loose.

Tight-fitting coverings may take the form of a quarter mask, a half mask, a full facepiece, or a mouth bit. A quarter mask covers both the nose and the mouth. The sealing surface extends from the bridge of the nose to below the lips (a quarter of the face). A half facepiece forms a seal from the bridge of the nose to underneath the chin (half the face). The seal of a full facepiece extends from above the eyes (but below the hair line) to underneath the chin (covering the full face).

With a respirator employing a mouth bit, the mechanism for covering the respiratory system inlets is slightly different. The person bites onto a rubber bit that is attached to the respirator and uses a nose clip to seal the nose. Thus both of the respiratory system inlets are sealed. Mouth bit type respirators are a special type that are used only in situations that call for escape from a hazardous atmosphere. They will not be discussed further in this chapter, since their use is so specialized.

The quarter, half or full-face types of coverings can be used with either an air-purifying or supplied-air type of respirator. The mouth bit type exists only as an air-purifying type.

Loose-fitting inlet coverings, as suggested by their name, do not rely on a sealing surface to protect the worker’s respiratory system. Rather they cover the face, head, or head and shoulders, providing a safe environment. Also included in this group are suits that cover the entire body. (Suits do not include garments that are worn solely to protect the skin, such as splash suits.) Since they do not seal to the face, loose-fitting inlet coverings operate only in systems that provide a flow of air. The flow of air must be greater than the air required for breathing to prevent the contaminant outside the respirator from leaking to the inside.

Air-purifying respirators

An air-purifying respirator causes ambient air to be passed through an air-purifying element that removes the contaminants. Air is passed through the air-purifying element by means of the breathing action (negative pressure respirators) or by a blower (powered air-purifying respirators, or PAPRs).

The type of air-purifying element will determine which contaminants are removed. Filters of varying efficiencies are used to remove aerosols. The choice of filter will depend on the properties of the aerosol; normally, particle size is the most important characteristic. Chemical cartridges are filled with a material that is specifically chosen to absorb or react with the vapour or gaseous contaminant.

Supplied-air respirators

Atmosphere-supplying respirators are a class of respirators that supply a respirable atmosphere independent of the workplace atmosphere. One type is commonly called an air-line respirator and operates in one of three modes: demand, continuous flow or pressure demand. Respirators operating in demand and pressure-demand modes can be equipped with either a half-face or a full facepiece inlet covering. The continuous-flow type can also be equipped with a helmet/hood or a loose-fitting facepiece.

A second type of atmosphere-supplying respirator, called a self-contained breathing apparatus (SCBA), is equipped with a self-contained air supply. It may be used for escape only or for entry into and escape from a hazardous atmosphere. The air is supplied from a compressed-air cylinder or by a chemical reaction.

Some supplied-air respirators are equipped with a small supplemental air bottle. The air bottle provides the person using the respirator with the ability to escape if the main air supply fails.

Combination units

Some specialized respirators may be made to operate both in a supplied-air mode and in an air-purifying mode. They are called combination units.

Respiratory Protection Programmes

For a respirator to function as intended, a minimal respirator programme needs to be developed. Regardless of the type of respirator used, the number of people involved and the complexity of the respirator use, there are basic considerations that need to be included in every programme. For simple programmes, adequate requirements may be minimal. For larger programmes, one may have to prepare for a complex undertaking.

By way of illustration, consider the need of keeping records of fit testing of equipment. For a one- or two-person programme, the date of last fit test, the respirator fit tested and the procedure could be kept on a simple card, while for a large programme with hundreds of users, a computerized database with a system to track those persons who are due for fit testing may be required.

The requirements for a successful programme are described in the following six sections.

1. Programme administration

The responsibility for the respirator programme should be assigned to a single person, called the programme administrator. A single person is assigned this task so that management clearly understands who is responsible. Just as important, this person is given the status necessary to make decisions and run the programme.

The programme administrator should have sufficient knowledge of respiratory protection to supervise the respirator programme in a safe and effective manner. The programme administrator’s responsibilities include the monitoring of respiratory hazards, maintaining records and conducting programme evaluations.

2. Written operating procedures

Written procedures are used to document the programme so that each participant knows what needs to be done, who is responsible for the activity and how it is to be carried out. The procedure document should include a statement of the goals of the programme. This statement would make it clear that the management of the company is responsible for the health of the workers and the implementation of the respirator programme. A written document setting forth the essential procedures of a respirator programme should cover the following functions:

  • respirator selection
  • maintenance, inspection and repair
  • training of employees, supervisors and the person issuing the respirators
  • fit testing
  • administrative activities including purchasing, inventory control and record keeping
  • monitoring of hazards
  • monitoring of respirator use
  • medical evaluation
  • the provision of emergency-use respirators
  • programme evaluation.

 

3. Training

Training is an important part of a respirator programme. The supervisor of the people using respirators, the users themselves and the people who issue respirators to the users all need to be trained. The supervisor needs to know enough about the respirator being used and why it is being used so that he or she will be able to monitor for proper usage: in effect, the person issuing the respirator to the user needs enough training to be sure that the correct respirator is handed out.

The workers who use respirators need to be given training and periodic retraining. The training should include explanations and discussions of the following:

  1. the nature of the respiratory hazard and possible health effects if the respirator is not used properly
  2. the reason a particular type of respirator was selected
  3. how the respirator works and its limitations
  4. how to put the respirator on and check that it is working and adjusted properly
  5. how to maintain, inspect and store the respirator
  6. a respirator fit test for negative pressure respirators.

 

4. Respirator maintenance

Respirator maintenance includes regular cleaning, inspection for damage, and replacement of worn parts. The manufacturer of the respirator is the best source of information on how to perform cleaning, inspection, repair and maintenance.

Respirators need to be cleaned and sanitized periodically. If a respirator is to be used by more than a single person, it should be cleaned and sanitized before being worn by others. Respirators intended for emergency use should be cleaned and sanitized after each use. This procedure should not be neglected, since there may be special needs to keep the respirator functioning properly. This may include controlled temperatures for cleaning solutions to prevent damage to the device’s elastomers. Furthermore, some parts may need to be cleaned carefully or in a special manner to avoid damage. The manufacturer of the respirator will provide a suggested procedure.

After cleaning and sanitizing, each respirator needs to be inspected to determine if it is in proper working condition, if it needs replacement of parts or repairs, or if it should be discarded. The user should be sufficiently trained and familiar with the respirator in order to be able to inspect the respirator immediately prior to each use in order to ensure that it is in proper working condition.

Respirators that are stored for emergency use need to be periodically inspected. A frequency of once each month is suggested. Once an emergency use respirator is used, it needs to be cleaned and inspected prior to re-use or storage.

In general, inspection will include a check for tightness of connections; for the condition of the respiratory inlet covering, head harness, valves, connecting tubes, harness assemblies, hoses, filters, cartridges, canisters, end of service life indicator, electrical components and shelf life date; and for the proper function of regulators, alarms and other warning systems.

Particular care needs to be given in the inspection of the elastomers and plastic parts commonly found on this equipment. Rubber or other elastomeric parts can be inspected for pliability and signs of deterioration by stretching and bending the material, looking for signs of cracking or wear. Inhalation and exhalation valves are generally thin and easily damaged. One should also look for the build-up of soaps or other cleaning materials on the sealing surfaces of valve seats. Damage or build-up can cause undue leakage through the valve. Plastic parts need to be inspected for damage, such as having stripped or broken threads on a cartridge, for example.

Air and oxygen cylinders should be inspected to determine that they are fully charged according to the manufacturer’s instructions. Some cylinders require periodic inspection to make sure the metal itself is not damaged or rusting. This might include periodic hydrostatic testing of the integrity of the cylinder.

Parts that are found to be defective need to be replaced by stock supplied by the manufacturer itself. Some parts may look very similar to another manufacturer’s, but may perform differently in the respirator itself. Anyone making repairs should to be trained in proper respirator maintenance and assembly.

For supplied-air and self-contained equipment, a higher level of training is required. Reducing or admission valves, regulators and alarms should be adjusted or repaired only by the respirator manufacturer or by a technician trained by the manufacturer.

Respirators that do not meet applicable inspection criteria should be immediately removed from service and repaired or replaced.

Respirators need to be properly stored. Damage can occur if they are not protected from physical and chemical agents such as vibration, sunlight, heat, extreme cold, excessive moisture or damaging chemicals. The elastomers used in the facepiece can be easily damaged if not protected. Respirators should not be stored in such places as lockers and tool boxes unless they are protected from contamination and damage.

5. Medical evaluations

Respirators may affect the health of the person using the equipment because of added stress on the pulmonary system. It is recommended that a physician evaluate each respirator user to determine that he or she can wear a respirator without difficulty. It is up to the physician to determine what will constitute a medical evaluation. A physician may or may not require a physical examination as part of the health assessment.

To perform this task the physician must be given information on the type of respirator being used and the type and length of work the worker will be performing while using the respirator. For most respirators, a normal healthy individual will not be affected by respirator wear, especially in the case of the lightweight air-purifying types.

Someone expected to use an SCBA under emergency conditions will need a more careful evaluation. The weight of the SCBA by itself adds considerably to the amount of work that must be performed.

6. Approved respirators

Many governments have systems to test and approve the performance of respirators for use in their jurisdictions. In such cases, an approved respirator should be used since the fact of its approval indicates that the respirator has met some minimum requirement for performance. If no formal approval is required by the government, any validly approved respirator is likely to provide better assurance that it will perform as intended when compared to a respirator that has gone through no special approval testing whatsoever.

Problems Affecting Respirator Programmes

There are several areas of respirator use that may lead to difficulties in managing a respirator programme. These are the wearing of facial hair and the compatibility of glasses and other protective equipment with the respirator being worn.

Facial hair

Facial hair can present a problem in managing a respirator programme. Some workers like to wear beards for cosmetic reasons. Others experience difficulty shaving, suffering from a medical condition where the facial hairs curl and grow into the skin after shaving. When a person inhales, negative pressure is built up inside the respirator, and if the seal to the face is not tight, contaminants can leak inside. This applies to both air-purifying and supplied-air respirators. The issue is how to be fair, to allow people to wear facial hair, yet to be protective of their health.

There are several research studies that demonstrate that facial hair in the sealing surface of a tight-fitting respirator leads to excessive leakage. Studies have also shown that in connection with facial hair the amount of leakage varies so widely that it is not possible to test whether workers may receive adequate protection even if their respirators were measured for fit. This means that a worker with facial hair wearing a tight-fitting respirator may not be sufficiently protected.

The first step in the solution of this problem is to determine if a loose-fitting respirator can be used. For each type of tight-fitting respirator—except for self contained breathing apparatus and combination escape/air-line respirators—a loose-fitting device is available that will provide comparable protection.

Another alternative is to find another job for the worker which does not require the use of a respirator. The final action that can be taken is to require the worker to shave. For most people who have difficulty shaving, a medical solution can be found that would allow them to shave and wear a respirator.

Eyeglasses and other protective equipment

Some workers need to wear eyeglasses in order to see adequately and in some industrial environments, safety glasses or goggles have to be worn to protect the eyes from flying objects. With a half-mask respirator, eyeglasses or goggles can interfere with the fit of the respirator at the point where it is seated on the bridge of the nose. With a full facepiece, the temple bars of a pair of eyeglasses would create an opening in the sealing surface of the respirator, causing leakage.

Solutions to these difficulties run as follows. For half-mask respirators, a fit test is first carried out, during which the worker should wear any glasses, goggles or other protective equipment that may interfere the respirator’s function. The fit test is used to demonstrate that eyeglasses or other equipment will not interfere with the function of the respirator.

For full-facepiece respirators, the options are to use contact lenses or special eyeglasses that mount inside the facepiece—most manufacturers supply a special spectacles kit for this purpose. At times, it has been thought that contact lenses should not be used with respirators, but research has shown that workers can use contact lenses with respirators without any difficulty.

Suggested Procedure for Respirator Selection

Selecting a respirator involves analysing how the respirator will be used and understanding the limitations of each specific type. General considerations include what the worker will be doing, how the respirator will be used, where the work is located and any limitations a respirator may have on work, as shown schematically in figure 1.

Figure 1. Guide to Respirator Selection

PPE080F3

Worker activity and worker location in a hazardous area need to be considered in selecting the proper respirator (for example, whether the worker is in the hazardous area continuously or intermittently during the work shift and whether the work rate is light, medium or heavy). For continuous use and heavy work a lightweight respirator would be preferred.

Environmental conditions and level of effort required of the respirator wearer may affect respirator service life. For example, extreme physical exertion can cause the user to deplete the air supply in a SCBA such that its service life is reduced by half or more.

The period of time that a respirator must be worn is an important factor that has to be taken into account in selecting a respirator. Consideration should be given to the type of task—routine, nonroutine, emergency, or rescue work—that the respirator will be called upon to perform.

The location of the hazardous area with respect to a safe area having respirable air must be considered in selecting a respirator. Such knowledge will permit planning for the escape of workers if an emergency occurs, for the entry of workers to perform maintenance duties and for rescue operations. If there is a long distance to breathable air or if the worker needs to be able to walk around obstacles or climb steps or ladders, then a supplied-air respirator would not be a good choice.

If the potential for an oxygen-deficient environment exists, measure the oxygen content of the relevant work space. The class of respirator, air-purifying or supplied-air, that can be used will depend on the partial pressure of oxygen. Because air-purifying respirators only purify the air, sufficient oxygen must be present in the surrounding atmosphere to support life in the first place.

Respirator selection involves reviewing each operation to ascertain what dangers may be present (hazard determination) and to select the type or class of respirators that can offer adequate protection.

Hazard Determination Steps

In order to determine the properties of the contaminants that may be present in the workplace, one should consult the key source for this information, namely, the supplier of the material. Many suppliers provide their customers with a material safety data sheet (MSDS) which reports the identity of the materials in a product and supplies information on exposure limits and toxicity as well.

One should determine whether there is a published exposure limit such as a threshold limit value (TLV), permissible exposure limit (PEL), maximum acceptable concentration, (MAK), or any other available exposure limit or estimate of toxicity for the contaminants. It ought to be ascertained whether a value for the immediately dangerous to life or health (IDLH) concentration for the contaminant is available. Each respirator has some use limitation based on the level of exposure. A limit of some sort is needed to determine whether the respirator will provide sufficient protection.

Steps should be taken to discover if there is a legally mandated health standard for the given contaminant (as there is for lead or asbestos). If so, there may be specific respirators required that will help narrow the selection process.

The physical state of the contaminant is an important characteristic. If an aerosol, its particle size should be determined or estimated. The vapour pressure of an aerosol is also significant at the maximum expected temperature of the work environment.

One should determine whether the contaminant present can be absorbed through the skin, produce skin sensitization or be irritating or corrosive to the eyes or skin. It should also be found for a gaseous or vapour contaminant if a known odour, taste or irritation concentration exists.

Once the identity of the contaminant is known, its concentration needs to be determined. This is normally done by collecting the material on a sample medium with subsequent analysis by a laboratory. Sometimes the assessment can be accomplished by estimating exposures, as described below.

Estimating Exposure

Sampling is not always required in hazard determination. Exposures can be estimated by examining data relating to similar tasks or by calculation by means of a model. Models or judgment can be used to estimate the likely maximum exposure and this estimate can be used to select a respirator. (The most basic models suitable to such a purpose is the evaporation model, a given amount of material is either assumed or allowed to evaporate into an air space, its vapour concentration found, and an exposure estimated. Adjustments can be made for dilution effects or ventilation.)

Other possible sources of exposure information are articles in journals or trade publications which present exposure data for various industries. Trade associations and data collected in hygiene programmes for similar processes are also useful for this purpose.

Taking protective action based on estimated exposure involves making a judgement based on experience vis-à-vis the type of exposure. For example, air monitoring data of previous tasks will not be useful in the event of the first occurrence of a sudden break in a delivery line. The possibility of such accidental releases must be anticipated in the first place before the need of a respirator can be decided, and the specific type of respirator chosen can then be made on the basis of the estimated likely concentration and nature of the contaminant. For example, for a process involving toluene at room temperatures, a safety device that offers no more protection than a continuous-flow air line need be chosen, since the concentration of toluene would not be expected to exceed its IDLH level of 2,000 ppm. However, in the case of a break in a sulphur dioxide line, a more effective device—say, an air-supplied respirator with an escape bottle—would be called for, since a leak of this sort could quite readily result in an ambient concentration of contaminant above the IDLH level of 20 ppm. In the next section, respirator selection will be examined in further detail.

Specific Respirator Selection Steps

If one is unable to determine what potentially hazardous contaminant may be present, the atmosphere is considered immediately dangerous to life or health. An SCBA or air line with an escape bottle is then required. Similarly, if no exposure limit or guideline is available and estimates of the toxicity cannot be made, the atmosphere is considered IDLH and an SCBA is required. (See the discussion below on the subject of IDLH atmospheres.)

Some countries have very specific standards governing respirators that can be used in given situations for specific chemicals. If a specific standard exists for a contaminant, the legal requirements must be followed.

For an oxygen-deficient atmosphere, the type of respirator selected depends on the partial pressure and concentration of oxygen and the concentration of the other contaminants that may be present.

Hazard ratio and assigned protection factor

The measured or estimated concentration of a contaminant is divided by its exposure limit or guideline to obtain its hazard ratio. With respect to this contaminant, a respirator is selected that has an assigned protection factor (APF) greater than the value of the hazard ratio (the assigned protection factor is the estimated performance level of a respirator). In many countries, a half mask is assigned an APF of ten. It is assumed that the concentration inside the respirator will be reduced by a factor of ten, that is, the APF of the respirator.

The assigned protection factor can be found in any existent regulations on respirator use or in the American National Standard for Respiratory Protection (ANSI Z88.2 1992). ANSI APFs are listed in table 2.

 


Table 2. Assigned protection factors from ANSI Z88 2 (1992)

 

Type of respirator

Respiratory inlet covering

 

Half mask1

Full facepiece

Helmet/hood

Loose-fitting facepiece

Air-Purifying

10

100

   

Atmosphere-supplying

SCBA (demand-type)2

10

100

   

Airline(demand-type)

10

100

   

Powered air-purifying

50

10003

10003

25

Atmosphere-supplying air-line type

Pressure-fed demand type

50

1000

Continuous Flow

50

1000

1000

25

Self-contained breathing apparatus

Positive pressure (demand open/closed circuit)

4

1 Includes one-quarter mask, disposable half masks and half masks with elastomeric facepieces.
2 Demand SCBA shall not be used for emergency situations such as fire fighting.
3 Protection factors listed are for high efficiency filters and sorbents (cartridges and canisters). With dust filters an assigned protection factor of 100 is to be used due to the limitations of the filter.
4 Although positive pressure respirators are currently regarded as providing the highest level of respiratory protection, a limited number of recent simulated workplace studies concluded that all users may not achieve protection factors of 10,000. Based on this limited data, a definitive assigned protection factor could not be listed for positive pressure SCBAs. For emergency planning purposes where hazardous concentrations can be estimated, an assigned protection factor of no higher than 10,000 should be used.

Note: Assigned protection factors are not applicable for escape respirators. For combination respirators, e.g., air-line respirators equipped with an air-purifying filter, the mode of operation in use will dictate the assigned protection factor to be applied.

Source: ANSI Z88.2 1992.


 

For example, for a styrene exposure (exposure limit of 50 ppm) with all of the measured data at the worksite less than 150 ppm, the hazard ratio is 3 (that is, 150 ¸ 50 = 3). Selection of a half-mask respirator with an assigned protection factor of 10 will assure that most unmeasured data will be well below the assigned limit.

In some cases where “worst-case” sampling is done or only a few data are collected, judgement must be used to decide if enough data have been collected for an acceptably reliable assessment of exposure levels. For example, if two samples were collected for a short-term task that represents the “worst-case” for that task and both samples were less than two times the exposure limit (a hazard ratio of 2), a half-mask respirator (with an APF of 10) would likely be an appropriate choice and certainly a continuous-flow full facepiece respirator (with an APF of 1,000) would be sufficiently protective. The contaminant’s concentration must also be less than the maximum-use concentration of the cartridge/canister: this latter information is available from the manufacturer of the respirator.

Aerosols, gases and vapours

If the contaminant is an aerosol, a filter will have to be used; the choice of filter will depend on the efficiency of the filter for the particle. The literature provided by the manufacturer will provide guidance on the appropriate filter to use. For example, if the contaminant is a paint, lacquer or enamel, a filter designed specifically for paint mists may be used. Other special filters are designed for fumes or dust particles that are larger than usual.

For gases and vapours, adequate notice of cartridge failure is necessary. Odour, taste or irritation are used as indicators that the contaminant has “broken through” the cartridge. Therefore, the concentration at which the odour, taste or irritation is noted must be less than the exposure limit. If the contaminant is a gas or vapour that has poor warning properties, the use of an atmosphere-supplying respirator is generally recommended.

However, atmosphere-supplying respirators sometimes cannot be used because of the lack of an air supply or because of the need for worker mobility. In this case, air-purifying devices may be used, but it is necessary that it be equipped with an indicator signalling the end of the device’s service life so that the user will be given adequate warning prior to contaminant breakthrough. Another alternative is to use a cartridge change schedule. The change schedule is based on cartridge service data, expected concentration, pattern of use and duration of exposure.

Respirator selection for emergency or IDLH conditions

As noted above, IDLH conditions are presumed to exist when the concentration of a contaminant is not known. Furthermore, it is prudent to consider any confined space containing less than 20.9% oxygen as an immediate danger to life or health. Confined spaces present unique hazards. Lack of oxygen in confined spaces is the cause of numerous deaths and serious injuries. Any reduction in the percentage of oxygen present is proof, at a minimum, that the confined space is not adequately ventilated.

Respirators for use under IDLH conditions at normal atmospheric pressure include either a positive-pressure SCBA alone or a combination of a supplied-air respirator with an escape bottle. When respirators are worn under IDLH conditions, at least one standby person must be present in a safe area. The standby person needs to have the proper equipment available to assist the wearer of the respirator in case of difficulty. Communications have to be maintained between the standby person and the wearer. While working in the IDLH atmosphere, the wearer needs to be equipped with a safety harness and safety lines to permit his or her removal to a safe area, if necessary.

Oxygen-deficient atmospheres

Strictly speaking, oxygen deficiency is a matter only of its partial pressure in a given atmosphere. Oxygen deficiency can be caused by a reduction in the percentage of oxygen in the atmosphere or by reduced pressure, or both reduced concentration and pressure. At high altitudes, reduced total atmospheric pressure can lead to very low oxygen pressure.

Humans need a partial oxygen pressure of approximately 95 mm Hg (torr) to survive. The exact pressure will vary among people depending on their health and acclimatization to reduced oxygen pressure. This pressure, 95 mm Hg, is equivalent to 12.5% oxygen at sea level or 21% oxygen at an altitude of 4,270 meters. Such an atmosphere may adversely affect either the person with reduced tolerance to reduced oxygen levels or the unacclimatized person performing work requiring a high degree of mental acuity or heavy stress.

To prevent adverse effects, supplied-air respirators should be provided at higher oxygen partial pressures, for example, about 120 mm Hg or 16% oxygen content at sea level. A physician should be involved in any decisions where people will be required to work in reduced-oxygen atmospheres. There may be legally mandated levels of oxygen percent or partial pressure that require supplied-air respirators at different levels than these broadly general guidelines suggest.

Suggested Procedures for Fit Testing

Each person assigned a tight-fitting negative-pressure respirator needs to be fit tested periodically. Each face is different, and a specific respirator may not fit a given person’s face. Poor fit would allow contaminated air to leak into the respirator, lowering the amount of protection the respirator provides. A fit test needs to be repeated periodically and must be carried out whenever a person has a condition that may interfere with facepiece sealing, e.g., significant scarring in the area of the face seal, dental changes, or reconstructive or cosmetic surgery. Fit testing has to be done while the subject is wearing protective equipment such as spectacles, goggles, a face shield or a welding helmet that will be worn during work activities and could interfere with respirator fit. The respirator should be configured as it will be used, that is, with a chin canister or cartridge.

Fit test procedures

Respirator fit testing is conducted to determine if a particular model and size of mask fits an individual’s face. Before the test is made, the subject should be oriented on the respirator’s proper use and donning, and the test’s purpose and procedures should be explained. The person being tested should understand that the he or she is being asked to select the respirator that provides the most comfortable fit. Each respirator represents a different size and shape and, if fit properly and used properly, will provide adequate protection.

No one size or model of respirator will fit all types of faces. Different sizes and models will accommodate a broader range of facial types. Therefore, an appropriate number of sizes and models should be available from which a satisfactory respirator can be selected.

The person being tested should be instructed to hold each facepiece up to the face and eliminate those which obviously do not give a comfortable fit. Normally, selection will begin with a half mask, and if a good fit cannot be found, the person will need to test a full facepiece respirator. (A small percentage of users will not be able to wear any half mask.)

The subject should conduct a negative- or positive-pressure fit check according to the instructions provided by the manufacturer before the test is begun. The subject is now ready for fit testing by one of the methods listed below. Other fit test methods are available, including quantitative fit test methods which use instruments to measure leakage into the respirator. The fit test methods, which are outlined in the boxes here, are qualitative and do not require expensive test equipment. These are (1) the isoamyl acetate (IAA) protocol and (2) the saccharin solution aerosol protocol.

Test exercises. During the fit test, the wearer should carry out a number of exercises in order to verify that the respirator will allow him or her to perform a set of basic and necessary actions. The following six exercises are recommended: standing still, breathing normally, breathing deeply, moving the head from side to side, moving the head up and down, and speaking. (See figure 2 and figure 3).

Figure 2. Isoamly acetate quantitive fit-test method

PPE080F1

Figure 3. Sacharin aerosol quantitive fit-test method

PPE080F2

 

Back

Thursday, 17 March 2011 16:30

Protective Clothing

Hazards

There are several general categories of bodily hazards for which specialized clothing can provide protection. These general categories include chemical, physical and biological hazards. Table 1 summarizes these.

Table 1. Examples of dermal hazard categories

Hazard

Examples

Chemical

Dermal toxins
Systemic toxins
Corrosives
Allergens

Physical

Thermal hazards (hot/cold)
Vibration
Radiation
Trauma producing

Biological

Human pathogens
Animal pathogens
Environmental pathogens

 

Chemical hazards

Protective clothing is a commonly used control to reduce worker exposures to potentially toxic or hazardous chemicals when other controls are not feasible. Many chemicals pose more than one hazard (for example, a substance such as benzene is both toxic and flammable). For chemical hazards, there are at least three key considerations that need attention. These are (1) the potential toxic effects of exposure, (2) likely routes of entry, and (3) the exposure potentials associated with the work assignment. Of the three aspects, toxicity of the material is the most important. Some substances simply present a cleanliness problem (e.g., oil and grease) while other chemicals (e.g., contact with liquid hydrogen cyanide) could present a situation which is immediately dangerous to life and health (IDLH). Specifically, the toxicity or hazardousness of the substance by the dermal route of entry is the critical factor. Other adverse effects of skin contact, besides toxicity, include corrosion, promotion of cancer of the skin and physical trauma such as burns and cuts.

An example of a chemical whose toxicity is greatest by the dermal route is nicotine, which has excellent skin permeability but is not generally an inhalation hazard (except when self-administered). This is only one of many instances where the dermal route offers a much more significant hazard than the other routes of entry. As suggested above, there are many substances that are not generally toxic but are hazardous to the skin because of their corrosive nature or other properties. In fact, some chemicals and materials can offer an even greater acute risk through skin absorption than the most dreaded systemic carcinogens. For example, a single unprotected skin exposure to hydrofluoric acid (above 70% concentration) can be fatal. In this case, as little as a 5% surface burn typically results in death from the effects of the fluoride ion. Another example of a dermal hazard—though not an acute one—is the promotion of skin cancer by substances such as coal tars. An example of a material which has high human toxicity but little skin toxicity is inorganic lead. In this case the concern is contamination of the body or clothing, which could later lead to ingestion or inhalation, since the solid will not permeate intact skin.

Once an evaluation of the routes of entry and toxicity of the materials has been completed, an assessment of the likelihood of exposure needs to be carried out. For example, do workers have enough contact with a given chemical to become visibly wet or is exposure unlikely and protective clothing intended to act simply as a redundant control measure? For situations where the material is deadly although the likelihood of contact is remote, the worker must obviously be provided with the highest level of protection available. For situations where the exposure itself represents a very minimal risk (e.g., a nurse handling 20% isopropyl alcohol in water), the level of protection does not need to be fail-safe. This selection logic is essentially based on an estimate of the adverse effects of the material combined with an estimate of the likelihood of exposure.

The chemical resistance properties of barriers

Research showing the diffusion of solvents and other chemicals through “liquid-proof” protective clothing barriers has been published from the 1980s to the 1990s. For example, in a standard research test, acetone is applied to neoprene rubber (of typical glove thickness). After direct acetone contact on the normal outside surface, the solvent can normally be detected on the inside surface (the skin side) within 30 minutes, although in small quantities. This movement of a chemical through a protective clothing barrier is called permeation. The permeation process consists of the diffusion of chemicals on a molecular level through the protective clothing. Permeation occurs in three steps: absorption of the chemical at the barrier surface, diffusion through the barrier, and desorption of the chemical on the normal inside surface of the barrier. The time elapsed from the initial contact of the chemical on the outside surface until detection on the inside surface is called the breakthrough time. The permeation rate is the steady-state rate of movement of the chemical through the barrier after equilibrium is reached.

Most current testing of permeation resistance extends over periods of up to eight hours, reflecting normal work shifts. However, these tests are conducted under conditions of direct liquid or gaseous contact that typically do not exist in the work environment. Some would therefore argue that there is a significant “safety factor” built into the test. Countering this assumption are the facts that the permeation test is static while the work environment is dynamic (involving flexing of materials or pressures generated from gripping or other movement) and that there may exist prior physical damage to the glove or garment. Given the lack of published skin permeability and dermal toxicity data, the approach taken by most safety and health professionals is to select the barrier with no breakthrough for the duration of the job or task (usually eight hours), which is essentially a no-dose concept. This is an appropriately conservative approach; however, it is important to note that there is no protective barrier currently available which provides permeation resistance to all chemicals. For situations where the breakthrough times are short, the safety and health professional should select the barriers with the best performance (i.e., with the lowest permeation rate) while considering other control and maintenance measures as well (such as the need for regular clothing changes).

Aside from the permeation process just described, there are two other chemical resistance properties of concern to the safety and health professional. These are degradation and penetration. Degradation is a deleterious change in one or more of the physical properties of a protective material caused by contact with a chemical. For example, the polymer polyvinyl alcohol (PVA) is a very good barrier to most organic solvents, but is degraded by water. Latex rubber, which is widely used for medical gloves, is of course water resistant, but is readily soluble in such solvents as toluene and hexane: it would be plainly ineffective for protection against these chemicals. Secondly, latex allergies can cause severe reactions in some people.

Penetration is the flow of a chemical through pinholes, cuts or other imperfections in protective clothing on a nonmolecular level. Even the best protective barriers will be rendered ineffective if punctured or torn. Penetration protection is important when the exposure is unlikely or infrequent and the toxicity or hazard is minimal. Penetration is usually a concern for garments used in splash protection.

Several guides have been published listing chemical resistance data (many are also available in an electronic format). In addition to these guides, most manufacturers in the industrially developed countries also publish current chemical and physical resistance data for their products.

Physical hazards

As noted in table 1, physical hazards include thermal conditions, vibration, radiation and trauma as all having the potential to affect the skin adversely. Thermal hazards include the adverse effects of extreme cold and heat on the skin. The protective attributes of clothing with respect to these hazards is related to its degree of insulation, whereas protective clothing for flash fire and electric flashover requires flame resistance properties.

Specialized clothing can provide limited protection from some forms of both ionizing and non-ionizing radiation. In general, the effectiveness of clothing that protects against ionizing radiation is based on the principle of shielding (as with lead-lined aprons and gloves), whereas clothing employed against non-ionizing radiation, such as microwave, is based on grounding or isolation. Excessive vibration can have several adverse effects on body parts, primarily the hands. Mining (involving hand-held drills) and road repair (for which pneumatic hammers or chisels are used), for example, are occupations where excessive hand vibration can lead to bone degeneration and loss of circulation in the hands. Trauma to the skin from physical hazards (cuts, abrasions, etc.) is common to many occupations, with construction and meat cutting as two examples. Specialized clothing (including gloves) are now available which are cut-resistant and are used in applications such as meat cutting and forestry (using chain saws). These are based either on inherent cut-resistance or the presence of enough fibre mass to clog moving parts (e.g., chain saws).

Biological hazards

Biological hazards include infection due to agents and disease common to humans and animals, and the work environment. Biological hazards common to humans have received great attention with the increasing spread of blood-borne AIDS and hepatitis. Hence, occupations which might involve exposure to blood or body fluids usually require some type of liquid-resistant garment and gloves. Diseases transmitted from animals through handling (e.g., anthrax) have a long history of recognition and require protective measures similar to those used for handling the kind of blood-borne pathogens that affect humans. Work environments that can present a hazard due to biological agents include clinical and microbiological laboratories as well as other special work environments.

Types of Protection

Protective clothing in a generic sense includes all elements of a protective ensemble (e.g., garments, gloves and boots). Thus, protective clothing can include everything from a finger cot providing protection against paper cuts to a fully encapsulating suit with a self-contained breathing apparatus used for an emergency response to a hazardous chemical spill.

Protective clothing can be made of natural materials (e.g., cotton, wool and leather), man-made fibres (e.g., nylon) or various polymers (e.g., plastics and rubbers such as butyl rubber, polyvinyl chloride, and chlorinated polyethylene). Materials which are woven, stitched or are otherwise porous (not resistant to liquid penetration or permeation) should not be used in situations where protection against a liquid or gas is required. Specially treated or inherently non-flammable porous fabrics and materials are commonly used for flash fire and electric arc (flashover) protection (e.g., in the petrochemical industry) but usually do not provide protection from any regular heat exposure. It should be noted here that fire-fighting requires specialized clothing that provides flame (burning) resistance, a water barrier and thermal insulation (protection from high temperatures). Some special applications also require infrared (IR) protection by use of aluminized overcovers (e.g., fighting petroleum fuel fires). Table 2 summarizes typical physical, chemical, and biological performance requirements and common protective materials used for hazard protection.

Table 2. Common physical, chemical and biological performance requirements

Hazard

Performance characteristic required

Common protective clothing materials

Thermal

Insulation value

Heavy cotton or other natural fabrics

Fire

Insulation and flame resistance

Aluminized gloves; flame resistent treated gloves; aramid fibre and other special fabrics

Mechanical abrasion

Abrasion resistence; tensile strength

Heavy fabrics; leather

Cuts and punctures

Cut resistance

Metal mesh; aromatic polyamide fiber and other special fabrics

Chemical/toxicological

Permeation resistance

Polymeric and elastomeric materials; (including latex)

Biological

“Fluid-proof”; (puncture resistant)

 

Radiological

Usually water resistance or particle resistance (for radionuclides)

 

 

Protective clothing configurations vary greatly depending on the intended use. However, normal components are analogous to personal clothing (i.e., trousers, jacket, hood, boots and gloves) for most physical hazards. Special-use items for applications such as flame resistance in those industries involving the processing of molten metals can include chaps, armlets, and aprons constructed of both treated and untreated natural and synthetic fibres and materials (one historical example would be woven asbestos). Chemical protective clothing can be more specialized in terms of construction, as shown in figure 1 and figure 2.

Figure 1. A worker wearing gloves and a chemically protective garment pouring chemical

PPE070F3

Figure 2. Two workers in differing configurations of chemical protective clothing

PPE070F5

Chemically protective gloves are usually available in a wide variety of polymers and combinations; some cotton gloves, for example, are coated by the polymer of interest (by means of a dipping process). (See figure 3). Some of the new foil and multilaminate “gloves” are only two-dimensional (flat)—and hence have some ergonomic constraints, but are highly chemical resistant. These gloves typically work best when a form-fitting outer polymer glove is worn over the top of the inner flat glove (this technique is called double gloving) to conform the inner glove to the shape of the hands. Polymer gloves are available in a wide variety of thicknesses ranging from very light weight (<2 mm) to heavy weight (>5 mm) with and without inner liners or substrates (called scrims). Gloves are also commonly available in a variety of lengths ranging from approximately 30 centimetres for hand protection to gauntlets of approximately 80 centimetres, extending from the worker’s shoulder to the tip of the hand. The correct choice of length depends on the extent of protection required; however, the length should normally be sufficient to extend at least to the worker’s wrists so as to prevent drainage into the glove. (See figure 4).

Figure 3. Various types of chemically resistant gloves

MISSING

Figure 4. Natural-fibre gloves; also illustrates sufficient length for wrist protection

PPE070F7

Boots are available in a wide variety of lengths ranging from hip length to those that cover only the bottom of the foot. Chemical protective boots are available in only a limited number of polymers since they require a high degree of abrasion resistance. Common polymers and rubbers used in chemically resistant boot construction include PVC, butyl rubber and neoprene rubber. Specially constructed laminated boots using other polymers can also be obtained but are quite expensive and in limited supply internationally at the present time.

Chemical protective garments can be obtained as a one-piece fully encapsulating (gas-tight) garment with attached gloves and boots or as multiple components (e.g., trousers, jacket, hoods, etc.). Some protective materials used for construction of ensembles will have multiple layers or laminas. Layered materials are generally required for polymers that do not have good enough inherent physical integrity and abrasion resistance properties to permit manufacture and use as a garment or glove (e.g., butyl rubber versus Teflon®). Common support fabrics are nylon, polyester, aramides and fibreglass. These substrates are coated or laminated by polymers such as polyvinyl chloride (PVC), Teflon®, polyurethane and polyethylene.

Over the last decade there has been an enormous growth in the use of nonwoven polyethene and microporous materials for disposable suit construction. These spun-bonded suits, sometimes incorrectly called “paper suits,” are made using a special process whereby the fibres are bonded together rather than woven. These protective garments are low in cost and very light in weight. Uncoated microporous materials (called “breathable” because they allow some water vapour transmission and hence are less heat stressful) and spun-bonded garments have good applications as protection against particulates but are not normally chemical-or liquid-resistant. Spun-bonded garments are also available with various coatings such as polyethylene and Saranex®. Depending on the coating characteristics, these garments can offer good chemical resistance to most common substances.

Approval, Certification and Standards

The availability, construction, and design of protective clothing varies greatly throughout the world. As might be expected, approval schemes, standards and certifications also vary. Nevertheless, there are similar voluntary standards for performance throughout the United States (e.g., American Society for Testing and Materials—ASTM—standards), Europe (European Committee for Standardization—CEN—standards), and for some parts of Asia (local standards such as in Japan). The development of worldwide performance standards has begun through the International Organization for Standardization Technical Committee 94 for Personal Safety-Protective Clothing and Equipment. Many of the standards and test methods to measure performance developed by this group were based on either CEN standards or those from other countries such as the United States through the ASTM.

In the United States, Mexico, and most of Canada, no certification or approvals are required for most protective clothing. Exceptions exist for special applications such as pesticide applicators clothing (governed by pesticide labelling requirements). Nevertheless, there are many organizations that issue voluntary standards, such as the previously mentioned ASTM, the National Fire Protection Association (NFPA) in the United States and the Canadian Standards Organization (CSO) in Canada. These voluntary standards do significantly affect the marketing and sale of protective clothing and hence act much like mandated standards.

In Europe, the manufacturing of personal protective equipment is regulated under the European Community Directive 89/686/EEC. This directive both defines which products fall within the scope of the directive and classifies them into different categories. For categories of protective equipment where the risk is not minimal and where the user cannot readily identify the hazard easily, the protective equipment must meet standards of quality and manufacture detailed in the directive.

No protective equipment products may be sold within the European Community unless they have the CE (European Community) mark. Testing and quality assurance requirements must be followed to receive the CE mark.

Individual Capabilities and Needs

In all but a few cases, the addition of protective clothing and equipment will decrease productivity and increase worker discomfort. It may also lead to decreased quality, since error rates increase with the use of protective clothing. For chemical protective and some fire-resistant clothing there are some general guidelines that need to be considered concerning the inherent conflicts between worker comfort, efficiency and protection. First, the thicker the barrier the better (increases the time to breakthrough or provides greater thermal insulation); however, the thicker the barrier the more it will decrease ease of movement and user comfort. Thicker barriers also increase the potential for heat stress. Second, barriers which have excellent chemical resistance tend to increase the level of worker discomfort and heat stress because the barrier normally will also act as a barrier to water vapour transmission (i.e., perspiration). Third, the higher the overall protection of the clothing, the more time a given task will take to accomplish and the greater the chance of errors. There are also a few tasks where the use of protective clothing could increase certain classes of risk (e.g., around moving machinery, where the risk of heat stress is greater than the chemical hazard). While this situation is rare, it must be considered.

Other issues relate to the physical limitations imposed by using protective clothing. For example, a worker issued a thick pair of gloves will not be able to perform tasks easily that require a high degree of dexterity and repetitive motions. As another example, a spray painter in a totally encapsulating suit will usually not be able to look to the side, up or down, since typically the respirator and suit visor restrict the field of vision in these suit configurations. These are only some examples of the ergonomic restrictions associated with wearing protective clothing and equipment.

The work situation must always be considered in the selection of the protective clothing for the job. The optimum solution is to select the minimum level of protective clothing and equipment that is necessary to do the job safely.

Education and Training

Adequate education and training for users of protective clothing is essential. Training and education should include:

  • the nature and extent of the hazards
  • the conditions under which protective clothing should be worn
  • what protective clothing is necessary
  • the use and limitations of the protective clothing to be assigned
  • how to inspect, don, doff, adjust and wear the protective clothing properly
  • decontamination procedures, if necessary
  • signs and symptoms of overexposure or clothing failure
  • first aid and emergency procedures
  • the proper storage, useful life, care and disposal of protective clothing.

 

This training should incorporate at least all of the elements listed above and any other pertinent information that has not already been provided to the worker through other programmes. For those topical areas already provided to the worker, a refresher summary should still be provided for the clothing user. For example, if the signs and symptoms of overexposure have already been indicated to the workers as part of their training for working with chemicals, symptoms that are a result of significant dermal exposures versus inhalation should be reemphasized. Finally, the workers should have an opportunity to try out the protective clothing for a particular job before a final selection is made.

Knowledge of the hazard and of the limitations of the protective clothing not only reduces the risk to the worker but also provides the health and safety professional with a worker capable of providing feedback on the effectiveness of the protective equipment.

Maintenance

The proper storage, inspection, cleaning and repair of protective clothing is important to the overall protection provided by the products to the wearer.

Some protective clothing will have storage limitations such as a prescribed shelf life or required protection from UV radiation (e.g., sunlight, welding flash, etc.), ozone, moisture, temperature extremes or prevention of product folding. For example, natural rubber products usually call for all of the precautionary measures just listed. As another example, many of the encapsulating polymer suits can be damaged if folded rather than allowed to hang upright. The manufacturer or distributor should be consulted for any storage limitations their products may have.

Inspection of protective clothing should be performed by the user on a frequent basis (e.g., with each use). Inspection by co-workers is another technique which may be used to involve wearers in ensuring the integrity of the protective clothing they have to use. As a management policy, it is also advisable to require supervisors to inspect protective clothing (at appropriate intervals) that is used on a routine basis. Inspection criteria will depend on the intended use of the protective item; however, it would normally include examination for tears, holes, imperfections and degradation. As one example of an inspection technique, polymer gloves used for protection against liquids should be blown up with air to check for integrity against leaks.

Cleaning of protective clothing for reuse must be performed with care. Natural fabrics can be cleaned by normal washing methods if they are not contaminated with toxic materials. Cleaning procedures suitable for synthetic fibres and materials are commonly limited. For example, some products treated for flame resistance will lose their effectiveness if not properly cleaned. Clothing used for protection against chemicals which are not water-soluble often cannot be decontaminated by washing with simple soap or detergent and water. Tests performed on pesticide applicators’ clothing indicate that normal washing procedures are not effective for many pesticides. Dry cleaning is not recommended at all since it is often ineffective and can degrade or contaminate the product. It is important to consult the manufacturer or distributor of the clothing before attempting cleaning procedures that are not specifically known to be safe and workable.

Most protective clothing is not repairable. Repairs can be made on some few items such as fully encapsulating polymer suits. However, the manufacturer should be consulted for the proper repair procedures.

Use and Misuse

Use. First and foremost, the selection and proper use of protective clothing should be based on an assessment of the hazards involved in the task for which the protection is required. In light of the assessment, an accurate definition of the performance requirements and the ergonomic constraints of the job can be determined. Finally, a selection that balances worker protection, ease of use and cost can be made.

A more formal approach would be to develop a written model programme, a method that would reduce the chance of error, increase worker protection and establish a consistent approach to the selection and use of protective clothing. A model programme could contain the following elements:

  1. an organization scheme and administrative plan
  2. a risk assessment methodology
  3. an evaluation of other control options to protect the worker
  4. performance criteria for the protective clothing
  5. selection criteria and procedures to determine the optimum choice
  6. purchasing specifications for the protective clothing
  7. a validation plan for the selection made
  8. decontamination and reuse criteria, as applicable
  9. a user training programme
  10. 10.an auditing plan to assure that procedures are consistently followed.

 

Misuse. There are several examples of misuse of protective clothing that can commonly be seen in industry. Misuse is usually the result of a lack of understanding of the limitations of protective clothing on the part of management, of the workers, or of both. A clear example of bad practice is the use of nonflame-resistant protective clothing for workers who handle flammable solvents or who work in situations where open flames, burning coals or molten metals are present. Protective clothing made of polymeric materials such as polyethylene may support combustion and can actually melt into the skin, causing an even more severe burn.

A second common example is the reuse of protective clothing (including gloves) where the chemical has contaminated the inside of the protective clothing so that the worker increases his or her exposure on each subsequent use. One frequently sees another variation of this problem when workers use natural-fibre gloves (e.g., leather or cotton) or their own personal shoes to work with liquid chemicals. If chemicals are spilled on the natural fibres, they will be retained for long periods of time and migrate to the skin itself. Yet another variation of this problem is taking contaminated work clothing home for cleaning. This can result in the exposure of an entire family to harmful chemicals, a common problem because the work clothing is usually cleaned with the other articles of clothing of the family. Since many chemicals are not water-soluble, they can be spread to other articles of clothing simply by mechanical action. Several cases of this spread of contaminants have been noted, especially in industries which manufacture pesticides or process heavy metals (e.g., poisoning families of workers handling mercury and lead). These are only a few of the more prominent examples of the misuse of protective clothing. These problems can be overcome by simply understanding the proper use and limitations of the protective clothing. This information should be readily available from the manufacturer and health and safety experts.

 

Back

Thursday, 17 March 2011 16:15

Hearing Protection

Hearing Protectors

No one knows when people first discovered that covering the ears with the flats of the hands or plugging up the ear canals with one’s fingers was effective in reducing the level of unwanted sound—noise—but the basic technique has been in use for generations as the last line of defence against loud sound. Unfortunately, this level of technology precludes the use of most others. Hearing protectors, an obvious solution to the problem, are a form of noise control in that they block the path of the noise from the source to the ear. They come in various forms, as depicted in figure 1.

Figure 1. Examples of different types of hearing protectors

PPE060F1

An earplug is a device worn in the external ear canal. Premolded earplugs are available in one or more standard sizes intended to fit into the ear canals of most people. A formable, user-molded earplug is made of a pliable material that is shaped by the wearer to fit into the ear canal to form an acoustic seal. A custom-molded earplug is individually made to fit the particular ear of the wearer. Earplugs can be made from vinyl, silicone, elastomer formulations, cotton and wax, spun glass wool, and slow-recovery closed-cell foam.

A semi-insert earplug, also called an ear-canal cap, is worn against the opening of the external ear canal: the effect is similar to plugging one’s ear canal with a fingertip. Semi-insert devices are manufactured in one size and are designed to fit most ears. This sort of device is held in place by a lightweight headband with mild tension.

An earmuff is a device composed of a headband and two circumaural cups that are usually made of plastic. The headband may be made of metal or plastic. The circumaural ear cup completely encloses the outer ear and seals against the side of the head with a cushion. The cushion may be made of foam or it may be filled with fluid. Most earmuffs have a lining inside the ear cup to absorb the sound that is transmitted through the shell of the ear cup in order to improve the attenuation above approximately 2,000 Hz. Some earmuffs are designed so that the headband may be worn over the head, behind the neck or under the chin, although the amount of protection they afford may be different for each headband position. Other earmuffs are designed to fit on “hard hats.” These may offer less protection because the hard-hat attachment makes it more difficult to adjust the earmuff and they do not fit as wide a range of head sizes as do those with headbands.

In the United States there are 53 manufacturers and distributors of hearing protectors who, as of July 1994, sold 86 models of earplugs, 138 models of earmuffs, and 17 models of semi-insert hearing protectors. In spite of the diversity of hearing protectors, foam earplugs designed for one-time use account for more than half of the hearing protectors in use in the United States.

Last line of defence

The most effective way to avoid noise-induced hearing loss is to stay out of hazardous noise areas. In many work settings it is possible to redesign the manufacturing process so that operators work in enclosed, sound-attenuating control rooms. The noise is reduced in these control rooms to the point where it is not hazardous and where speech communication is not impaired. The next most effective way to avoid noise-induced hearing loss is to reduce the noise at the source so that it is no longer hazardous. This is often done by designing quiet equipment or retrofitting noise control devices to existing equipment.

When it is not possible to avoid the noise or to reduce the noise at the source, hearing protection becomes the last resort. As the last line of defence, having no backup, its effectiveness can often be abridged.

One of the ways to diminish the effectiveness of hearing protectors is to use them less than 100% of the time. Figure 2 shows what happens. Eventually, no matter how much protection is afforded by design, protection is reduced as percent of wearing time decreases. Wearers who remove an earplug or lift an earmuff to talk with fellow workers in noisy environments can severely reduce the amount of protection they receive.

Figure 2. Decrease in effective protection as time of non-use during an 8-hour day increases (based on 3-dB exchange rate)

PPE060F2

 

The Rating Systems and How to Use Them

There are many ways to rate hearing protectors. The most common methods are the single-number systems such as the Noise Reduction Rating (NRR) (EPA 1979) used in the United States and the Single Number Rating (SNR), used in Europe (ISO 1994). Another European rating method is the HML (ISO 1994) that uses three numbers to rate protectors. Finally, there are methods based on the attenuation of the hearing protectors for each of the octave bands, called the long or octave-band method in the United States and the assumed protection value method in Europe (ISO 1994).

All of these methods use the real-ear attenuation at threshold values of the hearing protectors as determined in laboratories according to relevant standards. In the United States, attenuation testing is done in accordance with ANSI S3.19, Method for the Measurement of Real-Ear Protection of Hearing Protectors and Physical Attenuation of Earmuffs (ANSI 1974). Although this standard has been replaced by a newer one (ANSI 1984), the US Environmental Protection Agency (EPA) controls the NRR on hearing protector labels and requires the older standard to be used. In Europe attenuation testing is done in accordance with ISO 4869-1 (ISO 1990).

In general, the laboratory methods require that sound-field hearing thresholds be determined both with the protectors fitted and with the ears open. In the United States the hearing protector must be fitted by the experimenter, while in Europe the subject, assisted by the experimenter, performs this task. The difference between the protectors-fitted and ears-open sound field thresholds is the real-ear attenuation at threshold. Data are collected for a group of subjects, presently ten in the United States with three trials each and 16 in Europe with one trial each. The average attenuation and associated standard deviations are calculated for each octave band tested.

For purposes of discussion, the NRR method and the long method are described and illustrated in table 1.

 


Table 1. Example calculation of the Noise Reduction Rating (NRR) of a hearing protector

 

Procedure:

  1. Tabulate the sound pressure levels of pink noise, arbitrarily set for simplicity of computation to a level of 100 dB in each octave band.
  2. Tabulate the adjustments for the C-weighting scale at each octave-band centre frequency.
  3. Add lines 1 and 2 to obtain the C-weighted octave-band levels and logarithmically combine the C-weighted octave-band levels to determine the C-weighted sound pressure level.
  4. Tabulate the adjustments for the A-weighting scale at each octave-band centre frequency.
  5. Add line 1 and line 4 to obtain the A-weighted octave-band levels.
  6. Tabulate the attenuation provided by the device.
  7. Tabulate the standard deviations of attenuation (times 2) provided by the device.
  8. Subtract the values of the mean attenuations (step 6) and add the values of the standard deviations times 2 (step 7) to the A-weighted values (step 5) to obtain the estimated A-weighted octave-band sound levels under the device as it was fitted and tested in the laboratory. Combine the A-weighted octave-band levels logarithmically to obtain the A-weighted sound level effective when the device is worn.
  9. Subtract the A-weighted sound pressure level (step 8) and a 3-dB safety factor from the C-weighted sound pressure level (step 3) to obtain the NRR.

Steps

Octave-band center frequency in Hz

 

125

250

500

1000

2000

4000

8000

dBX

1. Assumed octave-band level of noise

100.0

100.0

100.0

100.0

100.0

100.0

100.0

 

2. C-weighting correction

–0.2

0.0

0.0

0.0

–0.2

–0.8

–3.0

 

3. C-weighted octave-band levels

99.8

100.0

100.0

100.0

99.8

99.2

97.0

107.9 dBC

4. A-weighting correction

–16.1

–8.6

–3.2

0.0

+1.2

+1.0

–1.1

 

5. A-weighted octave-band levels

83.9

91.4

96.8

100.0

101.2

101.0

98.9

 

6. Attenuation of hearing protector

27.4

26.6

27.5

27.0

32.0

46.01

44.22

 

7. Standard deviation × 2

7.8

8.4

9.4

6.8

8.8

7.33

12.84

 

8. Estimated protected A-weighted octave band levels

64.3

73.2

78.7

79.8

78.0

62.3

67.5

84.2 dBA

9. NRR = 107.9 – 84.2 – 3 = 20.7 (Step 3 – Step 8 – 3 dB5 )

1 Mean attenuation at 3000 and 4000 Hz.

2 Mean attenuation at 6000 and 8000 Hz.

3 Sum of standard deviations at 3000 and 4000 Hz.

4 Sum of standard deviations at 6000 and 8000 Hz.

5 The 3-dB correction factor is intended to account for spectrum uncertainty in that the noise in which the hearing protector is to be worn may deviate from the pink-noise spectrum used to calculate the NRR.


 

The NRR may be used to determine the protected noise level, that is, the effective A-weighted sound pressure level at the ear, by subtracting it from the C-weighted environmental noise level. Thus, if the C-weighted environmental noise level was 100 dBC and the NRR for the protector was 21 dB, the protected noise level would be 79 dBA (100–21 = 79). If only the A-weighted environmental noise level is known, a 7-dB correction is used (Franks, Themann and Sherris 1995). So, if the A-weighted noise level was 103 dBA, the protected noise level would be 89 dBA (103–[21-7] = 89).

The long method requires that the octave-band environmental noise levels be known; there is no shortcut. Many modern sound level meters can simultaneously measure octave-band, C-weighted and A-weighted environmental noise levels. However, no dosimeters currently provide octave-band data. Calculation by the long method is described below and shown in table 2.

 


Table 2. Example of the long method for computing the A-weighted noise reduction for a hearing protector in a known environmental noise

 

Procedure:

  1. Tabulate the measured octave-band levels of the environmental noise.
  2. Tabulate the adjustments for A-weighting at each octave-band centre frequency.
  3. Add the results of steps 1 and 2 to obtain the A-weighted octave-band levels. Combine the A-weighted octave-band levels logarithmically to obtain the A-weighted environmental noise level.
  4. Tabulate the attenuation provided by the device for each octave band.
  5. Tabulate the standard deviations of attenuation (times 2) provided by the device for each octave band.
  6. Obtain the A-weighted octave-band levels under the protector by subtracting the mean attenuation (step 4) from the A-weighted octave-band levels (step 3),  and adding the standard deviation of the attenuations times 2 (step 5). The A-weighted octave band levels are combined logarithmically to obtain the A-weighted  sound level effective when the hearing protector is worn. The estimated A-weighted noise reduction in a given environment is calculated by subtracting the  A-weighted sound level under the protector from the A-weighted environmental noise level (the result of step 3 minus that of step 6).

Steps

Octave-band center frequency in Hz

 

125

250

500

1000

2000

4000

8000

dBA

1. Measured octave-band levels of noise

85.0

87.0

90.0

90.0

85.0

82.0

80.0

 

2. A-weighting correction

–16.1

–8.6

–3.2

0.0

+1.2

+1.0

–1.1

 

3. A-weighted octave-band levels

68.9

78.4

86.8

90.0

86.2

83.0

78.9

93.5

4. Attenuation of hearing protector

27.4

26.6

27.5

27.0

32.0

46.01

44.22

 

5. Standard deviation × 2

7.8

8.4

9.4

6.8

8.8

7.33

12.84

 

6. Estimated protected
A-weighted octave-band levels.
(Step 3 – Step 4 + Step 5)

49.3

60.2

68.7

69.8

63.0

44.3

47.5

73.0

1 Mean attenuation at 3000 and 4000 Hz.

2 Mean attenuation at 6000 and 8000 Hz.

3 Sum of standard deviations at 3000 and 4000 Hz.

4 Sum of standard deviations at 6000 and 8000 Hz.


 

The subtractive standard deviation corrections in the long method and in the NRR computations are intended to use the laboratory variability measurements to adjust the estimates of protection to correspond to values expected for most of the users (98% with a 2-standard-deviation correction or 84% if a 1-standard-deviation correction is used) who wear the hearing protector under conditions identical to those involved in the testing. The appropriateness of this adjustment is, of course, heavily dependent upon the validity of the laboratory-estimated standard deviations.

Comparison of the long method and the NRR

The long method and the NRR computations may be compared by subtracting the NRR (20.7) from the C-weighted sound pressure level for the spectrum in table 2 (95.2 dBC) to predict the effective level when the hearing protector is worn, namely 74.5 dBA. This compares favourably to the value of 73.0 dBA derived from the long method in table 2. Part of the disparity between the two estimates is due to the use of the approximate 3 dB spectral safety factor incorporated in line 9 of table 1. The spectral safety factor is intended to account for errors arising from the use of an assumed noise instead of an actual noise. Depending upon the slope of the spectrum and the shape of the attenuation curve of the hearing protector, the differences between the two methods may be greater than that shown in this example.

Reliability of test data

It is unfortunate that the attenuation values and their standard deviations as obtained in laboratories in the United States, and to a lesser extent in Europe, are not representative of those obtained by everyday wearers. Berger, Franks and Lindgren (1996) reviewed 22 real-world studies of hearing protectors and found that US laboratory values reported on the EPA-required label overestimated protection from 140 to almost 2000%. The overestimation was greatest for earplugs and least for earmuffs. Since 1987, the US Occupational Safety and Health Administration has recommended that the NRR be derated by 50% before calculations are made of noise levels under the hearing protector. In 1995, the US National Institute for Occupational Safety and Health (NIOSH) recommended that the NRR for earmuffs be derated by 25% that the NRR for formable earplugs be derated by 50% and that the NRR for premolded earplugs and semi inserts be derated by 70% before calculations of noise levels under the hearing protector are made (Rosenstock 1995).

Intra- and inter-laboratory variability

Another consideration, but of less impact than the real-world issues noted above, is within-laboratory validity and variability, as well as differences between facilities. Inter-laboratory variability can be substantial (Berger, Kerivan and Mintz 1982), affecting both the octave-band values and the computed NRRs, both in terms of absolute computations as well as rank ordering. Therefore, even rank ordering of hearing protectors based on attenuation values is best done at present only for data from a single laboratory.

Important Points for Selecting Protection

When a hearing protector is selected, there are several important points to be considered (Berger 1988). Foremost is that the protector will be adequate for the environmental noise in which it will be worn. The Hearing Conservation Amendment to the OSHA Noise Standard (1983) recommends that the noise level under the hearing protector be 85 dB or less. NIOSH has recommended that the noise level under the hearing protector be no higher than 82 dBA, so that risk of noise-induced hearing loss is minimal (Rosenstock 1995).

Second, the protector should not be overprotective. If the protected exposure level is more than 15 dB below the desired level, the hearing protector has too much attenuation and the wearer is considered to be overprotected, resulting in the wearer’s feeling isolated from the environment (BSI 1994). It may be difficult to hear speech and warning signals and wearers will temporarily either remove the protector when they need to communicate (as mentioned above) and verify warning signals or they will modify the protector to reduce its attenuation. In either case, the protection will usually be reduced to the point that hearing loss is no longer being prevented.

At present, accurate determination of protected noise levels is difficult since reported attenuations and standard deviations, along with their resultant NRRs, are inflated. However, using the derating factors recommended by the NIOSH should improve accuracy of such a determination in the short run.

Comfort is a critical issue. No hearing protector can be as comfortable as not wearing one at all. Covering or occluding the ears produces many unnatural sensations. These range from a change in the sound of one’s own voice due to the “occlusion effect” (see below), to a feeling of fullness of the ears or pressure on the head. Use of earmuffs or earplugs in hot environments may be uncomfortable because of the increase in perspiration. It will take time for wearers to get used to the sensations caused by hearing protectors and to some of the discomfort. However, when wearers experience such types of discomfort as headache from headband pressure or pain in the ear canals from earplug insertion, they should be fitted with alternative devices.

If earmuffs or reusable earplugs are used, a means to keep them clean should be provided. For earmuffs, wearers should have easy access to replaceable components such as ear cushions and ear cup liners. Wearers of disposable earplugs should have ready access to a fresh supply. If one intends to have earplugs reused, wearers should have access to earplug cleaning facilities. Wearers of custom-molded earplugs should have facilities to keep the earplugs clean and access to new earplugs when they have become damaged or worn out.

The average American worker is exposed to 2.7 occupational hazards each and every day (Luz et al. 1991). These hazards may require the use of other protective equipment such as “hard hats,” eye protection and respirators. It is important that any hearing protector selected be compatible with other safety equipment that is required. The NIOSH Compendium of Hearing Protective Devices (Franks, Themann and Sherris 1995) has tables that, among other things, list the compatibility of each hearing protector with other safety equipment.

The Occlusion Effect

The occlusion effect describes the increase in the efficiency with which bone-conducted sound is transmitted to the ear at frequencies below 2,000 Hz when the ear canal is sealed with a finger or an earplug, or is covered by an earmuff. The magnitude of the occlusion effect depends upon how the ear is occluded. The maximum occlusion effect occurs when the entrance to the ear canal is blocked. Earmuffs with large ear cups and earplugs that are deeply inserted cause less of an occlusion effect (Berger 1988). The occlusion effect often causes hearing protector wearers to object to wearing protection because they dislike the sound of their voices—louder, booming and muffled.

Communication Effects

Because of the occlusion effect that most hearing protectors cause, one’s own voice tends to sound louder—since the hearing protectors reduce the level of environmental noise, the voice sounds much louder than when the ears are open. To adjust for the increased loudness of one’s own speech, most wearers tend to lower their voice levels substantially, speaking more softly. Lowering the voice in a noisy environment where the listener is also wearing hearing protection contributes to the difficulty of communicating. Furthermore, even without an occlusion effect, most speakers raise their voice levels by only 5 to 6 dB for every 10 dB increase in environmental noise level (the Lombard effect). Thus, the combination of lowered voice level because of the use of hearing protection combined with inadequate elevation of voice level to make up for environmental noise has severe consequences on the ability of hearing-protector wearers to hear and understand each other in noise.

The Operation of Hearing Protectors

Earmuffs

The basic function of earmuffs is to cover the outer ear with a cup that forms a noise-attenuating acoustic seal. The styles of the ear cup and the earmuff’s cushions as well as the tension provided by the headband determine, for the most part, how well the earmuff attenuates environmental noise. Figure 3 displays both an example of a well-fitted earmuff with a good seal all around the outer ear as well as an example of an earmuff with a leak underneath the cushion. The chart in figure 3 shows that while the tight-fitting earmuff has good attenuation at all frequencies, the one with a leak provides practically no low-frequency attenuation. Most earmuffs will provide attenuation approaching bone conduction, approximately 40 dB, for frequencies from 2,000 Hz and greater. The low-frequency attenuation properties of a tightly fitting earmuff are determined by design features and materials that include ear cup volume, the area of the ear cup opening, headband force and mass.

Figure 3. Well-fitted and poorly fitted earmuffs and their attenuation consequences

PPE060F3

Earplugs

Figure 4 displays an example of a well-fitted, fully inserted foam earplug (about 60% of it extends into the ear canal) and an example of a poorly fitted, shallowly inserted foam earplug that just caps the ear canal entrance. The well-fitted earplug has good attenuation at all frequencies. The poorly fitted foam earplug has substantially less attenuation. The foam earplug, when fitted properly, can provide attenuation approaching bone conduction at many frequencies. In high-level noise, the differences in attenuation between a well-fitted and a poorly fitted foam earplug can be sufficient to either prevent or permit noise-induced hearing loss.

Figure 4. A well-fitted and a poorly fitted foam earplug and the attenuation consequences

PPE060F4

Figure 5 displays a well-fitted and poorly fitted premolded earplug. In general, premolded earplugs do not provide the same degree of attenuation as properly fitted foam earplugs or earmuffs. However, the well-fitted premolded earplug provides adequate attenuation for most industrial noises. The poorly fitted premolded earplug provides substantially less, and no attenuation at 250 and 500 Hz. It has been observed that for some wearers, there is actually gain at these frequencies, meaning that the protected noise level is actually higher than the environmental noise level, putting the wearer at more risk of developing noise-induced hearing loss than if the protector were not worn at all.

Figure 5. A well-fitted and a poorly fitted premolded earplug

PPE060F5

Dual hearing protection

For some environmental noises, especially when daily equivalent exposures exceed about 105 dBA, a single hearing protector may be insufficient. In such situations wearers can use both earmuffs and earplugs in combination to achieve about 3 to 10 dB of extra protection, limited primarily by the bone conduction of the head of the wearer. Attenuation changes very little when different earmuffs are used with the same earplug, but changes greatly when different earplugs are used with the same earmuff. For dual protection, the choice of the earplug is critical for attenuation below 2,000 Hz, but at and above 2,000 Hz essentially all earmuff/earplug combinations provide attenuation approximately equal to the skull’s bone-conduction pathways.

Interference from glasses and head-worn personal protective equipment

Safety glasses, or other devices such as respirators that interfere with the earmuff’s circumaural seal, can degrade earmuff attenuation. For example, eye wear can reduce attenuation in individual octave bands by 3 to 7 dB.

Flat-response devices

A flat-attenuation earmuff or earplug is one that provides approximately equal attenuation for frequencies from 100 to 8,000 Hz. These devices maintain the same frequency response as the unoccluded ear, providing undistorted audition of signals (Berger 1991). A normal earmuff or earplug may sound as if the treble of the signal has been turned down, in addition to the overall lowering of the sound level. The flat-attenuation earmuff or earplug will sound as if only the volume has been reduced since its attenuation characteristics are “tuned” by the use of resonators, dampers and diaphragms. Flat-attenuation characteristics can be important for wearers having high-frequency hearing loss, for those for whom understanding speech while being protected is important, or for those for whom having high-quality sound is important, such as musicians. Flat attenuation devices are available as earmuffs and earplugs. One drawback of the flat-attenuation devices is that they don’t provide as much attenuation as conventional earmuffs and earplugs.

Passive amplitude-sensitive devices

A passive amplitude-sensitive hearing protector has no electronics and is designed to allow voice communications during quiet periods and provide little attenuation at low noise levels with protection increasing as the noise level increases. These devices contain orifices, valves, or diaphragms intended to produce this nonlinear attenuation, typically beginning once sound levels exceed 120 dB sound pressure levels (SPL). At sound levels below 120 dB SPL, orifice and valve-type devices typically act as vented earmolds, providing as much as 25 dB of attenuation at the higher frequencies, but very little attenuation at and below 1,000 Hz. Few occupational and recreational activities, other than shooting competitions (especially in outdoor environments), are appropriate if this type of hearing protector is expected to be truly effective in preventing noise-induced hearing loss.

Active amplitude-sensitive devices

An active amplitude-sensitive hearing protector has electronics and design goals similar to a passive amplitude-sensitive protector. These systems employ a microphone placed on the exterior of the ear cup or ported to the lateral surface of the earplug. The electronic circuit is designed to provide less and less amplification, or in some cases to completely shut down, as the environmental noise level increases. At the levels of normal conversational speech, these devices provide unity gain, (the loudness of speech is the same as if the protector wasn’t worn), or even a small amount of amplification. The goal is to keep the sound level under the earmuff or earplug to less than a 85 dBA diffuse-field equivalent. Some of the units built into earmuffs have a channel for each ear, thus allowing some level of localization to be maintained. Others have only one microphone. The fidelity (naturalness) of these systems varies among manufacturers. Because of the electronics package built into the ear cup which is necessary to have an active level-dependent system, these devices provide about four to six decibels less attenuation in their passive state, electronics turned off, than similar earmuffs without the electronics.

Active noise reduction

Active noise reduction, while an old concept, is a relatively new development for hearing protectors. Some units work by capturing the sound inside the ear cup, inverting its phase, and retransmitting the inverted noise into the ear cup to cancel the incoming sound. Other units work by capturing sound outside the ear cup, modifying its spectrum to account for the attenuation of the ear cup, and inserting the inverted noise into the ear cup, effectively using the electronics as a timing device so that the electrically inverted sound arrives in the ear cup at the same time as the noise transmitted through the ear cup. Active noise reduction is limited to the reduction of low-frequency noises below 1,000 Hz, with a maximum attenuation of 20 to 25 dB occurring at or below 300 Hz.

However, a portion of the attenuation provided by the active noise reduction system simply offsets the reduction in attenuation of the earmuffs that is caused by the inclusion in the ear cup of the very electronics which are required to effect the active noise reductions. At present these devices cost 10 to 50 times that of passive earmuffs or earplugs. If the electronics fail, the wearer may be inadequately protected and could experience more noise under the ear cup than if the electronics were simply shut off. As active noise cancellation devices become more popular, costs should diminish and their applicability may become more widespread.

The Best Hearing Protector

The best hearing protector is the one that the wearer will use willingly, 100% of the time. It is estimated that approximately 90% of noise-exposed workers in the manufacturing sector in the United States are exposed to noise levels of less than 95 dBA (Franks 1988). They need between 13 and 15 dB of attenuation to provide them with adequate protection. There are a wide array of hearing protectors that can provide sufficient attenuation. Finding the one that each worker will wear willingly 100% of the time is the challenge.

 

Back

Thursday, 17 March 2011 16:09

Head Protection

Head Injuries

Head injuries are fairly common in industry and account for 3 to 6% of all industrial injuries in industrialized countries. They are often severe and result in an average lost time of about three weeks. The injuries sustained are generally the result of blows caused by the impact of angular objects such as tools or bolts falling from a height of several metres; in other cases, workers may strike their heads in a fall to a floor or suffer a collision between some fixed object and their heads.

A number of different types of injury have been recorded:

  • perforation of the skull resulting from the application of an excessive force to a very localized area, as for example in the case of direct contact with a pointed or sharp-edged object
  • fracture of the skull or of the cervical vertebrae occurring when an excessive force is applied on a larger area, stressing the skull beyond the limits of its elasticity or compressing the cervical portion of the spine
  • brain lesions without fracture of the skull resulting from the brain being displaced suddenly within the skull, which may lead to contusion, concussion, haemorrhage of the brain or circulatory problems.

 

Understanding the physical parameters that account for these various types of injury is difficult, although of fundamental importance, and there is considerable disagreement in the extensive literature published on this subject. Some specialists consider that the force involved is the principal factor to be considered, while others claim that it is a matter of energy, or of the quantity of movement; further opinions relate the brain injury to acceleration, to acceleration rate, or to a specific shock index such as HIC, GSI, WSTC. In most cases, each one of these factors is likely to be involved to a greater or lesser extent. It may be concluded that our knowledge of the mechanisms of shocks to the head is still only partial and controversial. The shock tolerance of the head is determined by means of experimentation on cadavers or on animals, and it is not easy to extrapolate these values to a living human subject.

On the basis of the results of analyses of accidents sustained by building workers wearing safety helmets, however, it seems that head injuries due to shocks occur when the quantity of energy involved in the shock is in excess of about 100 J.

Other types of injuries are less frequent but should not be overlooked. They include burns resulting from splashes of hot or corrosive liquids or molten material, or electrical shocks resulting from accidental contact of the head with exposed conductive parts.

Safety Helmets

The chief purpose of a safety helmet is to protect the head of the wearer against hazards, mechanical shocks. It may in addition provide protection against other for example, mechanical, thermal and electrical.

A safety helmet should fulfil the following requirements in order to reduce the harmful effects of shocks to the head:

  1. It should limit the pressure applied to the skull by spreading the load over the largest possible surface. This is achieved by providing a sufficiently large harness that closely match various skull shapes, together with a hard shell strong enough to prevent the head from coming into direct contact with accidentally falling objects and to provide protection if the wearer’s head should hit a hard surface (figure 1). The shell must therefore resist deformation and perforation.
  2. It should deflect falling objects by having a suitably smooth and rounded shape. A helmet with protruding ridges tends to arrest falling objects rather than to deflect them and thus retain slightly more kinetic energy than helmets which are perfectly smooth.
  3. It should dissipate and disperse the energy that may be transmitted to it in such a way that the energy is not passed totally to the head and neck. This is achieved by means of the harness, which must be securely fixed to the hard shell so that it can absorb a shock without being detached from the shell. The harness must also be flexible enough to undergo deformation under impact without touching the inside surface of the shell. This deformation, which absorbs most of the energy of a shock, is limited by the minimum amount of clearance between the hard shell and the skull and by the maximum elongation of the harness before it breaks. Thus the rigidity or stiffness of the harness should be the result of a compromise between the maximum amount of energy that it is designed to absorb and the progressive rate at which the shock is to be allowed to be transmitted to the head.

 

Figure 1. Example of essential elements of safety helmet construction

PPE050F1Other requirements may apply to helmets used for particular tasks. These include protection against splashes of molten metal in the iron and steel industry and protection against electrical shock by direct contact in the case of helmets used by electrical technicians.

Materials used in the manufacture of helmets and harnesses should retain their protective qualities over a long period of time and under all foreseeable climatic conditions, including sun, rain, heat, bela-freezing temperature, and so on. Helmets should also have a fairly good resistance to flame and should                                                                                                                         not break if dropped onto a hard surface from a height of a few                                                                                                                         metres.

Performance Tests

ISO International Standard No. 3873-1977 was published in 1977 as a result of the work of the subcommittee dealing especially with “industrial safety helmets”. This standard, approved by practically all the member states of the ISO, sets out the essential features required of a safety helmet together with the related testing methods. These tests may be divided into two groups (see table 1), namely:

  1. obligatory tests, to be applied to all types of helmets for whatever use they may be intended: shock-absorbing capacity, resistance to perforation and resistance to flame
  2. optional tests, intended to be applied to safety helmets designed for special groups of users: dielectric strength, resistance to lateral deformation and resistance to low temperature.

 

Table 1. Safety helmets: testing requirements of ISO Standard 3873-1977

Characteristic

Description

Criteria

Obligatory tests

Absorption of shocks

A hemispherical mass of 5 kg is allowed to fall from a height of
1 m and the force transmitted by the helmet to fixed false (dummy) head is measured.

The maximum force measured should not exceed 500 daN.

 

The test is repeated on a helmet at temperatures of –10°, +50°C and under wet conditions.,

 

Resistance to penetration

The helmet is struck within a zone of 100 mm in diameter on its uppermost point using a conical punch weighing 3 kg and a tip angle of 60°.

The tip of the punch must not come into contact with the false (dummy) head.

 

Test to be performed under the conditions which gave the worst results in the shock test.,

 

Resistance to flame

The helmet is exposed for 10 s to a Bunsen burner flame of 10 mm in diameter using propane.

The outer shell should not continue to burn more than 5 s after it has been withdrawn from the flame.

Optional tests

Dielectric strength

The helmet is filled with a solution of NaCl and is itself immersed in a bath of the same solution. The electric leakage under an applied voltage of 1200 V, 50 Hz is measured.

The leakage current should not be greater than 1.2 mA.

Lateral rigidity

The helmet is placed sideways between two parallel plates and subjected to a compressive pressure of 430 N

The deformation under load should not exceed 40 mm, and the permanent deformation should not be more than 15 mm.

Low-temperature test

The helmet is subject to the shock and penetration tests at a temperature of -20°C.

The helmet must fulfil the foregoing requirements for these two tests.

 

The resistance to ageing of the plastic materials used in the manufacture of helmets is not specified in ISO No. 3873-1977. Such a specification should be required for helmets made out of plastic materials. A simple test consists in exposing the helmets to a high-pressure, quartz-envelope 450 watt xenon lamp over a period of 400 hours at a distance of 15 cm, followed by a check to ensure that the helmet can still withstand the appropriate penetration test.

It is recommended that helmets intended for use in the iron and steel industry be subjected to a test for resistance to splashes of molten metal. A quick way of carrying out this test is to allow 300 grams of molten metal at 1,300°C to drop onto the top of a helmet and to check that none has passed through to the interior.

The European Standard EN 397 adopted in 1995 specifies requirements and test methods for these two important characteristics.

Selection of a Safety Helmet

The ideal helmet providing protection and perfect comfort in every situation has yet to be designed. Protection and comfort are indeed often conflicting requirements. As regards protection, in selecting a helmet, the hazards against which protection is required and the conditions under which the helmet will be used must be considered with specific attention to the characteristics of the available safety products.

General considerations

It is advisable to choose helmets complying with the recommendations of ISO Standard No. 3873 (or its equivalent). The European Standard EN 397-1993 is used as a reference for the certification of helmets in application of the 89/686/EEC directive: equipment undergoing such certification, as is the case with almost all personal protective equipment, is submitted to a mandatory third party certification before being put onto the European market. In any case, helmets should meet the following requirements:

  1. A good safety helmet for general use should have a strong shell able to resist deformation or puncture (in the case of plastics, the shell wall should be not less than 2 mm in thickness), a harness fixed in such a way as to ensure that there is always a minimum clearance of 40 to 50 mm between its upper side and the shell, and an adjustable headband fitted to the cradle to ensure a close and stable fit (see figure 1).
  2. The best protection against perforation is provided by helmets made of thermoplastic materials (polycarbonates, ABS, polyethylene and polycarbonate–glass fibre) and fitted with a good harness. Helmets made of light metal alloys do not stand up well to puncture by pointed or sharp-edged objects.
  3. Helmets with protruding parts inside the shell should not be used, as these may cause serious injuries in the case of a sideways blow; they should be fitted with a lateral protective padding that must be neither flammable nor subject to melting under the effect of heat. A padding made of fairly rigid and flame resistant foam, 10 to 15 mm thick and at least 4 cm wide will serve this purpose.
  4. Helmets made of polyethylene, polypropylene or ABS tend to lose their mechanical strength under the effects of heat, cold and particularly heavy exposure to sunlight or ultraviolet (UV) radiation. If such helmets are regularly used in the open air or near UV sources like welding stations, they should be replaced at least every three years. Under such conditions, it is recommended that polycarbonate, polyester or polycarbonate–glass fibre helmets be used, as these have a better resistance to ageing. In any case, any evidence of discoloration, cracks, shredding of fibres or of creaking when the helmet is twisted, should cause the helmet to be discarded.
  5. Any helmet that has been submitted to a heavy blow, even if there are no evident signs of damage, should be discarded.

 

Special considerations

Helmets made of light alloys or having a brim along the sides should not be used in workplaces where there is a hazard of molten metal splashes. In such cases, the use of polyester–glass fibre, phenol textile, polycarbonate–glass fibre or polycarbonate helmets is recommended.

Where there is a hazard of contact with exposed conductive parts, only helmets made of thermoplastic material should be used. They should not have ventilation holes and no metal parts such as rivets should appear on the outside of the shell.

Helmets for persons working overhead, particularly steel framework erectors, should be provided with chin straps. The straps should be about 20 mm in width and should be such that the helmet is held firmly in place at all times.

Helmets made largely of polyethene are not recommended for use at high temperatures. In such cases, polycarbonate, polycarbonate–glass fibre, phenol textile, or polyester–glass fibre helmets are more suitable. The harness should be made of woven fabric. Where there is no hazard of contact with exposed conductive parts, ventilation holes in the helmet shell may be provided.

Situations where there is a crushing hazard call for helmets made of glass–fibre reinforced polyester or polycarbonate having a rim with a width of not less than 15 mm.

Comfort considerations

In addition to safety, consideration should also be given to the physiological aspects of comfort for the wearer.

The helmet should be as light as possible, certainly not more than 400 grams in weight. Its harness should be flexible and permeable to liquid and should not irritate or injure the wearer; for this reason, harnesses of woven fabric are to be preferred to those made of polyethene. A full or half leather sweatband should be incorporated not only in order to provide sweat absorption but also to reduce skin irritation; it should be replaced several times during the life of the helmet for hygienic reasons. To ensure better thermal comfort, the shell should be of a light colour and have ventilation holes with a surface range of 150 to 450 mm2. Careful adjustment of the helmet to fit the wearer is necessary in order to ensure its stability and to prevent its slipping and reducing the field of vision. Various helmet shapes are available, the most common being the “cap” shape with a peak and a brim around the sides; for work in quarries and on demolition sites, the “hat” type of helmet with a wider brim provides better protection. A “skull-cap” shaped helmet without a peak or a brim is particularly suitable for persons working overhead as this pattern precludes a possible loss of balance caused by the peak or brim coming into contact with joists or girders among which the worker may have to move.

Accessories and Other Protective Headgear

Helmets may be fitted with eye or face shields made of plastic material, metallic mesh or optical filters; hearing protectors, chin straps and nape straps to keep the helmet firmly in position; and woollen neck protectors or hoods against wind or cold (figure 2). For use in mines and underground quarries, attachments for a headlamp and a cable holder are fitted.

Figure 2. Example of safety helmet with chin strap (a), optical filter (b) and woolen neck protector against wind and cold (c)

PPE050F2

Other types of protective headgear include those designed for protection against dirt, dust, scratches and bumps. Sometimes known as “bump caps,” these are made of light plastic material or linen. For persons working near machine tools such as drills, lathes, spooling machines and so forth, where there is a risk of the hair being caught, linen caps with a net, peaked hair nets or even scarves or turbans may be used, provided that they have no                                                                                                                     exposed loose ends.

Hygiene and Maintenance

All protective headgear should be cleaned and checked regularly. If splits or cracks appear, or if a helmet shows signs of ageing or deterioration of the harness, the helmet should be discarded. Cleaning and disinfection are particularly important if the wearer sweats excessively or if more than one person share the same headgear.

Substances adhering to a helmet such as chalk, cement, glue or resin may be removed mechanically or by using an appropriate solvent that does not attack the shell material. Warm water with a detergent may be used with a hard brush.

For disinfecting headgear, articles should be dipped into a suitable disinfecting solution such as a 5% formalin solution or a sodium hypochlorite solution.

 

Back

Thursday, 17 March 2011 16:05

Foot and Leg Protection

Injuries to the foot and leg are common to many industries. The dropping of a heavy object may injure the foot, particularly the toes, in any workplace, especially among workers in the heavier industries such as mining, metal manufacture, engineering and building and construction work. Burns of the lower limbs from the molten metals, sparks or corrosive chemicals occur frequently in foundries, iron- and steelworks, chemical plants and so on. Dermatitis or eczema may be caused by a variety of acidic, alkaline and many other agents. The foot may also suffer physical injury caused by striking it against an object or by stepping on sharp protrusions such as can occur in the construction industry.

Improvements in the work environment have made the simple puncturing and laceration of the worker’s foot by protruding floor nails and other sharp hazards less common, but accidents from working on damp or wet floors still occur, particularly when wearing unsuitable foot wear.

Types of Protection.

The type of foot and leg protection should be related to the risk. In some light industries, it may be sufficient hat workers wear well-made ordinary shoes. Many women, for example will wear footwear that is comfortable to them, such as sandals or old slippers, or footwear with very high or worn-down heels. This practice should be discouraged because such footwear can cause an accident.

Sometimes a protective shoe or clog is adequate, and sometimes a boot or leggings will be required (see figure 1, figure 2 and figure 3). The height to which the footwear covers the ankle, knee or thigh depends on the hazard, although comfort and mobility will also have to be considered. Thus shoes and gaiters may in some circumstances be preferable to high boots.

Figure 1. Safety shoes

PPE030F1

Figure 2. Heat protective boots

PPE030F2

Figure 3. Safety sneakers

PPE030F3

Protective shoes and boots may be made from leather, rubber, synthetic rubber or plastic and may be fabricated by sewing, vulcanizing or moulding. Since the toes are most vulnerable to impact injuries, a steel toe cap is the essential feature of protective footwear wherever such hazards exist. For comfort the toe cap must be reasonably thin and light, and carbon tool steel is therefore used for this purpose. These safety toe caps may be incorporated into many types of boots and shoes. In some trades where falling objects present a particular risk, metal instep guards may be fitted over protective shoes.

Rubber or synthetic outer soles with various tread patterns are used to minimize or prevent the risk of slipping: this is especially important where floors are likely to be wet or slippery. The material of the sole appears to be of more importance than the tread pattern and should have a high coefficient of friction. Reinforced, puncture-proof soles are necessary in such places as construction sites; metallic insoles can also be inserted into various types of footwear that lack this protection.

Where an electrical hazard exists, shoes should be either entirely stitched or cemented, or directly vulcanized in order to avoid the need for nails or any other electrically conductive fasteners. Where static electricity may be present, protective shoes should have electrically conductive rubber outer soles to allow static electricity to leak from the bottom of the shoes.

Footwear with a dual purpose has now come into common use: these are shoes or boots that have both anti-electrostatic properties mentioned above together with the ability to protect the wearer from receiving an electrical shock when in contact with a low-voltage electrical source. In the latter case, the electrical resistance between the insole and the outer sole must be controlled in order to provide this protection between a given voltage range.

In the past, “safety and durability” were the only considerations. Now, worker comfort has also been taken into account, so that lightness, comfort and even attractiveness in protective shoes are sought-after qualities. The “safety sneaker” is one example of this kind of footwear. Design and colour may come to play a part in the use of footwear as an emblem of corporate identity, a matter that receives special attention in countries like Japan, to name only one.

Synthetic rubber boots offer useful protection from chemical injuries: the material should show not more than 10% reduction in tensile strength or elongation after immersion in a 20% solution of hydrochloric acid for 48 hours at room temperature.

Especially in environments where molten metals or chemical burns are a major hazard, it is important that shoes or boots should be without tongues and that the fastenings should be pulled over the top of the boot and not tucked inside.

Rubber or metallic spats, gaiters or leggings may be used to protect the leg above the shoe line, especially from risks of burns. Protective knee pads may be necessary, especially where work involves kneeling, for example in some foundry moulding. Aluminized heat-protective shoes, boots or leggings will be necessary near sources of intense heat.

Use and Maintenance

All protective footwear should be kept clean and dry when not in use and should be replaced as soon as necessary. In places where the same rubber boots are used by several people, regular arrangements for disinfection between each use should be made to prevent the spread of foot infections. A danger of foot mycosis exists that arises from the use of too tight and too heavy types of boots or shoes.

The success of any protective footwear depends upon its acceptability, a reality that is now widely recognized in the far greater attention that is now paid to styling. Comfort is a prerequisite and the shoes should be as light as is consistent with their purpose: shoes weighing more than two kilogram per pair should be avoided.

Sometimes foot and leg safety protection is required by law to be provided by the employers. Where the employers are interested in progressive programmes and not just meeting legal obligations, concerned companies often find it very effective to provide some arrangement for easy purchase at the place of work. And if protective wear can be offered at wholesale price, or arrangements for convenient extended payment terms are made available, workers may be more willing and able to purchase and use better equipment. In this way, the type of protection obtained and worn can be better controlled. Many conventions and regulations, however, do consider supplying workers with work clothing and protective equipment to be the employer’s obligation.

 

Back

Thursday, 17 March 2011 15:51

Eye and Face Protections

Eye and face protection includes safety spectacles, goggles, face shields and similar items used to protect against flying particles and foreign bodies, corrosive chemicals, fumes, lasers and radiation. Often, the whole face may need protection against radiation or mechanical, thermal or chemical hazards. Sometimes a face shield may be adequate also for protecting the eyes, but often specific eye protection is necessary, either separately or as a complement to the face protection.

A wide range of occupations require eye and face protectors: hazards include flying particles, fumes or corrosive solids, liquids or vapours in polishing, grinding, cutting, blasting, crushing, galvanizing or various chemical operations; against intensive light as in laser operations; and against ultraviolet or infrared radiation in welding or furnace operations. Of the many types of eye and face protection available, there is a correct type for each hazard. Whole-face protection is preferred for certain severe risks. As needed, hood or helmet type face protectors and face shields are used. Spectacles or goggles may be used for specific eye protection.

The two basic problems in wearing eye and face protectors are (1) how to provide effective protection which is acceptable for wearing over long hours of work without undue discomfort, and (2) the unpopularity of eye and face protection due to restriction of vision. The wearer’s peripheral vision is limited by the side frames; the nose bridge may disturb binocular vision; and misting is a constant problem. Particularly in hot climates or in hot work, additional coverings of the face may become intolerable and may be discarded. Short-term, intermittent operations also create problems as workers may be forgetful and disinclined to use protection. First consideration should always be given to the improvement of the working environment rather than to the possible need for personal protection. Before or in conjunction with the use of eye and face protection, consideration must be given to guarding of machines and tools (including interlocking guards), removal of fumes and dust by exhaust ventilation, screening of sources of heat or radiation, and screening of points from which particles may be ejected, such as abrasive grinders or lathes. When the eyes and face can be protected by the use of transparent screens or partitions of appropriate size and quality, for example, these alternatives are to be preferred to the use of personal eye protection.

There are six basic types of eye and face protection:

    1. spectacle type, either with or without side shields (figure 1)
    2. eye cup (goggle) type (figure 2)
    3. face shield type, covering eye sockets and the central portion of the face (figure 3)
    4. helmet type with shielding of the whole front of the face (figure 4)
    5. hand-held shield type (see figure 4)
    6. hood type, including the diver’s helmet type covering the head completely (see figure 4)

    Figure 1. Common types of spectacles for eye protection with or without sideshield

    PPE020F1

    Figure 2. Examples of goggle-type eye protectors

    PPE020F2.

    Figure 3. Face shield type protectors for hot work

    PPE020F3

    Figure 4. Protectors for welders

    PPE020F4

    There are goggles that may be worn over corrective spectacles. It is often better for the hardened lenses of such goggles to be fitted under the guidance of an ophthalmic specialist.

    Protection against Specific Hazards

    Traumatic and chemical injuries. Face shields or eye protectors are used against flying
    particles, fumes, dust and chemical hazards. Common types are spectacles (often with side shields), goggles, plastic eye shields and face shields. The helmet type is used when injury risks are expected from various directions. The hood type and the diver’s helmet type are used in sand- and shot-blasting. Transparent plastics of various sorts, hardened glass or a wire screen may be used for protection against certain foreign bodies. Eye cup goggles with plastic or glass lenses or plastic eye shields as well as a diver’s helmet type shield or face shields made of plastic are used for protection against chemicals.

    Materials commonly used include polycarbonates, acrylic resins or fibre-based plastics. Polycarbonates are effective against impacts but may not be suitable against corrosives. Acrylic protectors are weaker against impacts but suitable for protection from chemical hazards. Fibre-based plastics have the advantage of adding anti-misting coating. This anti-misting coating also prevents electrostatic effects. Thus such plastic protectors may be used not only in physically light work or chemical handling but also in modern clean-room work.

    Thermal radiation. Face shields or eye protectors against infrared radiation are used mainly in furnace operations and other hot work involving exposure to high-temperature radiation sources. Protection is usually necessary at the same time against sparks or flying hot objects. Face protectors of the helmet type and the face shield type are mainly used. Various materials are used, including metal wire meshes, punched aluminium plates or similar metal plates, aluminized plastic shields or plastic shields with gold layer coatings. A face shield made of wire mesh can reduce thermal radiation by 30 to 50%. Aluminized plastic shields give good protection from radiant heat. Some examples of face shields against thermal radiation are given in figure 1.

    Welding. Goggles, helmets or shields that give maximum eye protection for each welding and cutting process should be worn by operators, welders and their helpers. Effective protection is needed not only against intensive light and radiation but also against impacts upon the face, head and neck. Fibreglass-reinforced plastic or nylon protectors are effective but rather expensive. Vulcanized fibres are commonly used as shield material. As shown in figure 4, both helmet type protectors and hand-held shields are used to protect the eyes and face at the same time. Requirements for correct filter lenses to be used in various welding and cutting operations are described below.

    Wide spectral bands. Welding and cutting processes or furnaces emit radiations in the ultraviolet, visible and infrared bands of the spectrum, which are all able to produce harmful effects upon the eyes. Spectacle type or goggle type protectors similar to those shown in figure 1 and figure 2 as well as welders’ protectors such as those shown in figure 4 can be used. In welding operations, helmet type protection and hand-shield type protectors are generally used, sometimes in conjunction with spectacles or goggles. It should be noted that protection is necessary also for the welder’s assistant.

    Transmittance and tolerances in transmittance of various shades of filter lenses and filter plates of eye protection against high-intensity light are shown in table 1. Guides for selecting correct filter lenses in terms of the scales of protection are given in table 2 through table 6).

     


    Table 1. Transmittance requirements (ISO 4850-1979)

     

     

    Scale number

    Maximum transmittance

    in the ultraviolet spectrum t (), %

    Luminous transmittance ( ), %

    Maximum mean transmittance

    in the infrared spectrum , %

     

    313 nm

    365 nm

    maximum

    minimum

    Near IR

    1,300 to 780 nm,

    Mid. IR

    2,000 to 1,300 nm ,

    1.2

    1.4

    1.7

    2.0

    2.5

    3

    4

    5

    6

    7

    8

    9

    10

    11

    12

    13

    14

    15

    16

    0,0003

    0,0003

    0,0003

    0,0003

    0,0003

    0,0003

    0,0003

    0,0003

    0,0003

    0,0003

    0,0003

    0,0003

    0,0003

    Value less than or equal to transmittance  permitted for   365 nm

    50

    35

    22

    14

    6,4

    2,8

    0,95

    0,30

    0,10

    0,037

    0,013

    0,0045

    0,0016

    0,00060

    0,00020

    0,000076

    0,000027

    0,0000094

    0,0000034

    100

    74,4

    58,1

    43,2

    29,1

    17,8

    8,5

    3,2

    1,2

    0,44

    0,16

    0,061

    0,023

    0,0085

    0,0032

    0,0012

    0,00044

    0,00016

    0,000061

    74,4

    58,1

    43,2

    29,1

    17,8

    8,5

    3,2

    1,2

    0,44

    0,16

    0,061

    0,023

    0,0085

    0,0032

    0,0012

    0,00044

    0,00016

    0,000061

    0,000029

    37

    33

    26

    21

    15

    12

    6,4

    3,2

    1,7

    0,81

    0,43

    0,20

    0,10

    0,050

    0,027

    0,014

    0,007

    0,003

    0,003

    37

    33

    26

    13

    9,6

    8,5

    5,4

    3,2

    1,9

    1,2

    0,68

    0,39

    0,25

    0,15

    0,096

    0,060

    0,04

    0,02

    0,02

    Taken from ISO 4850:1979 and reproduced with the permission of the International Organization for Standardization (ISO). These standards can be obtained from any ISO member or from the ISO Central Secretariat, Case postale 56, 1211 Geneva 20, Switzerland. Copyright remains with ISO.


     

    Table 2. Scales of protection to be used for gas-welding and braze-welding

    Work to be carried out1

    l = flow rate of acetylene, in litres per hour

     

    l £ 70

    70 l £ 200

    200 l £ 800

    l > 800

    Welding and braze-welding
    of heavy metals

    4

    5

    6

    7

    Welding with emittive
    fluxes (notably light alloys)

    4a

    5a

    6a

    7a

    1 According to the conditions of use, the next greater or the next smaller scale can be used.

    Taken from ISO 4850:1979 and reproduced with the permission of the International Organization for Standardization (ISO). These standards can be obtained from any ISO member or from the ISO Central Secretariat, Case postale 56, 1211 Geneva 20, Switzerland. Copyright remains with ISO.


     

    Table 3. Scales of protection to be used for oxygen cutting

    Work to be carried out1

    Flow rate of oxygen, in litres per hour

     

    900 to 2,000

    2,000 to 4,000

    4,000 to 8,000

    Oxygen cutting

    5

    6

    7

    1 According to the conditions of use, the next greater or the next smaller scale can be used.

    NOTE: 900 to 2,000 and 2,000 to 8,000 litres of oxygen per hour, correspond fairly closely to the use of cutting nozzles diameters of 1 to 1.5 and 2 mm respectively.

    Taken from ISO 4850:1979 and reproduced with the permission of the International Organization for Standardization (ISO). These standards can be obtained from any ISO member or from the ISO Central Secretariat, Case postale 56, 1211 Geneva 20, Switzerland. Copyright remains with ISO.


     

    Table 4. Scales of protection to be used for plasma arc cutting

    Work to be carried out1

    l = Current, in amperes

     

    l £ 150

    150 l £ 250

    250 l £ 400

    Thermal cutting

    11

    12

    13

    1 According to the conditions of use, the next greater or the next smaller scale can be used.

    Taken from ISO 4850:1979 and reproduced with the permission of the International Organization for Standardization (ISO). These standards can be obtained from any ISO member or from the ISO Central Secretariat, Case postale 56, 1211 Geneva 20, Switzerland. Copyright remains with ISO.


     

    Table 5. Scales of protection to be used for electric arc welding or gouging

    1 According to the conditions of use, the next greater or the next smaller scale can be used.

    2 The expression “heavy metals” applies to steels, alloy stells, copper and its alloys, etc.

    NOTE: The coloured areas correspond to the ranges where the welding operations are not usually used in the current practice of manual welding.

    Taken from ISO 4850:1979 and reproduced with the permission of the International Organization for Standardization (ISO). These standards can be obtained from any ISO member or from the ISO Central Secretariat, Case postale 56, 1211 Geneva 20, Switzerland. Copyright remains with ISO.


     

    Table 6. Scales of protection to be used for plasma direct arc welding

    1 According to the conditions of use, the next greater or the next smaller scale can be used.

    The coloured areas correspond to the ranges where the welding operations are not usually used in the current practice of manual welding.

    Taken from ISO 4850:1979 and reproduced with the permission of the International Organization for Standardization (ISO). These standards can be obtained from any ISO member or from the ISO Central Secretariat, Case postale 56, 1211 Geneva 20, Switzerland. Copyright remains with ISO.


     

    A new development is the use of filter plates made of welded crystal surfaces which increase their protective shade as soon as the welding arc starts. The time for this nearly instantaneous shade increase can be as short as 0.1 ms. The good visibility through the plates in non-welding situations can encourage their use.

    Laser beams. No one type of filter offers protection from all laser wavelengths. Different kinds of lasers vary in wavelength, and there are lasers that produce beams of various wavelengths or those whose beams change their wavelengths by passing through optical systems. Consequently, laser-using firms should not depend solely on laser protectors to protect an employee’s eyes from laser burns. Nevertheless, laser operators do frequently need eye protection. Both spectacles and goggles are available; they have shapes similar to those shown in figure 1 and figure 2. Each kind of eyewear has maximum attenuation at a specific laser wavelength. Protection falls off rapidly at other wavelengths. It is essential to select the correct eyewear appropriate for the kind of laser, its wavelength and optical density. The eyewear is to provide protection from reflections and scattered lights and the utmost precautions are necessary to foresee and avoid harmful radiation exposure.

    With the use of eye and face protectors, due attention must be paid to greater comfort and efficiency. It is important that the protectors be fitted and adjusted by a person who has received some training in this task. Each worker should have the exclusive use of his or her own protector, while communal provision for cleaning and demisting may well be made in larger works. Comfort is particularly important in helmet and hood type protectors as they may become almost intolerably hot during use. Air lines can be fitted to prevent this. Where the risks of the work process allow, some personal choice among different types of protection is psychologically desirable.

    The protectors should be examined regularly to ensure that they are in good condition. Care should be taken that they give adequate protection at all times even with the use of corrective vision devices.

     

    Back

    Page 40 of 87

    " DISCLAIMER: The ILO does not take responsibility for content presented on this web portal that is presented in any language other than English, which is the language used for the initial production and peer-review of original content. Certain statistics have not been updated since the production of the 4th edition of the Encyclopaedia (1998)."

    Contents