A workplace hazard can be defined as any condition that may adversely affect the well-being or health of exposed persons. Recognition of hazards in any occupational activity involves characterisation of the workplace by identifying hazardous agents and groups of workers potentially exposed to these hazards. The hazards might be of chemical, biological or physical origin). Some hazards in the work environment are easy to recognise—for example, irritants, which have an immediate irritating effect after skin exposure or inhalation. Others are not so easy to recognise—for example, chemicals which are accidentally formed and have no warning properties. Some agents like metals (e.g., lead, mercury, cadmium, manganese), which may cause injury after several years of exposure, might be easy to identify if you are aware of the risk. A toxic agent may not constitute a hazard at low concentrations or if no one is exposed. Basic to the recognition of hazards are identification of possible agents at the workplace, knowledge about health risks of these agents and awareness of possible exposure situations.
Recognition of hazards
Recognition of hazards is a fundamental step in the practice of occupational hygiene, indispensable for the adequate planning of hazard evaluation and control strategies, as well as for the establishment of priorities for action. For the adequate design of control measures, it is also necessary to physically characterise contaminant sources and contaminant propagation paths.
The recognition of hazards leads to the determination of:
The identification of hazardous agents, their sources and the conditions of exposure requires extensive knowledge and careful study of work processes and operations, raw materials and chemicals used or generated, final products and eventual by-products, as well as of possibilities for the accidental formation of chemicals, decomposition of materials, combustion of fuels or the presence of impurities. The recognition of the nature and potential magnitude of the biological effects that such agents may cause if overexposure occurs, requires knowledge on and access to toxicological information.
Agents which pose health hazards in the work environment include airborne contaminants; non-airborne chemicals; physical agents, such as heat and noise; biological agents; ergonomic factors, such as inadequate lifting procedures and working postures; and psychosocial stresses.
Hazard surveillance and survey methods
Occupational surveillance involves active programmes to anticipate, observe, measure, evaluate and control exposures to potential health hazards in the workplace. Surveillance often involves a team of people that includes an occupational hygienist, occupational physician, occupational health nurse, safety officer, toxicologist and engineer. Depending upon the occupational environment and problem, three surveillance methods can be employed: medical, environmental and biological. Medical surveillance is used to detect the presence or absence of adverse health effects for an individual from occupational exposure to contaminants, by performing medical examinations and appropriate biological tests. Environmental surveillance is used to document potential exposure to contaminants for a group of employees, by measuring the concentration of contaminants in the air, in bulk samples of materials, and on surfaces. Biological surveillance is used to document the absorption of contaminants into the body and correlate with environmental contaminant levels, by measuring the concentration of hazardous substances or their metabolites in the blood, urine or exhaled breath of workers.
Medical surveillance is performed because diseases can be caused or exacerbated by exposure to hazardous substances. It requires an active programme with professionals who are knowledgeable about occupational diseases, diagnoses and treatment. Medical surveillance programmes provide steps to protect, educate, monitor and, in some cases, compensate the employee. It can include pre-employment screening programmes, periodic medical examinations, specialized tests to detect early changes and impairment caused by hazardous substances, medical treatment and extensive record keeping. Pre-employment screening involves the evaluation of occupational and medical history questionnaires and results of physical examinations. Questionnaires provide information concerning past illnesses and chronic diseases (especially asthma, skin, lung and heart diseases) and past occupational exposures. There are ethical and legal implications of pre-employment screening programmes if they are used to determine employment eligibility. However, they are fundamentally important when used to (1) provide a record of previous employment and associated exposures, (2) establish a baseline of health for an employee and (3) test for hyper-susceptibility. Medical examinations can include audiometric tests for hearing loss, vision tests, tests of organ function, evaluation of fitness for wearing respiratory protection equipment, and baseline urine and blood tests. Periodic medical examinations are essential for evaluating and detecting trends in the onset of adverse health effects and may include biological monitoring for specific contaminants and the use of other biomarkers.
Environmental and biological surveillance
Environmental and biological surveillance starts with an occupational hygiene survey of the work environment to identify potential hazards and contaminant sources and determine the need for monitoring. For chemical agents, monitoring could involve air, bulk, surface and biological sampling. For physical agents, monitoring could include noise, temperature and radiation measurements. If monitoring is indicated, the occupational hygienist must develop a sampling strategy that includes which employees, processes, equipment or areas to sample, the number of samples, how long to sample, how often to sample, and the sampling method. Industrial hygiene surveys vary in complexity and focus depending upon the purpose of the investigation, type and size of establishment, and nature of the problem.
There are no rigid formulas for performing surveys; however, thorough preparation prior to the on-site inspection significantly increases effectiveness and efficiency. Investigations that are motivated by employee complaints and illnesses have an additional focus of identifying the cause of the health problems. Indoor air quality surveys focus on indoor as well as outdoor sources of contamination. Regardless of the occupational hazard, the overall approach to surveying and sampling workplaces is similar; therefore, this chapter will use chemical agents as a model for the methodology.
Routes of exposure
The mere presence of occupational stresses in the workplace does not automatically imply that there is a significant potential for exposure; the agent must reach the worker. For chemicals, the liquid or vapour form of the agent must make contact with and/or be absorbed into the body to induce an adverse health effect. If the agent is isolated in an enclosure or captured by a local exhaust ventilation system, the exposure potential will be low, regardless of the chemical’s inherent toxicity.
The route of exposure can impact the type of monitoring performed as well as the hazard potential. For chemical and biological agents, workers are exposed through inhalation, skin contact, ingestion and injection; the most common routes of absorption in the occupational environment are through the respiratory tract and the skin. To assess inhalation, the occupational hygienist observes the potential for chemicals to become airborne as gases, vapours, dusts, fumes or mists.
Skin absorption of chemicals is important primarily when there is direct contact with the skin through splashing, spraying, wetting or immersion with fat-soluble hydrocarbons and other organic solvents. Immersion includes body contact with contaminated clothing, hand contact with contaminated gloves, and hand and arm contact with bulk liquids. For some substances, such as amines and phenols, skin absorption can be as rapid as absorption through the lungs for substances that are inhaled. For some contaminants such as pesticides and Benzedrine dyes, skin absorption is the primary route of absorption, and inhalation is a secondary route. Such chemicals can readily enter the body through the skin, increase body burden and cause systemic damage. When allergic reactions or repeated washing dries and cracks the skin, there is a dramatic increase in the number and type of chemicals that can be absorbed into the body. Ingestion, an uncommon route of absorption for gases and vapours, can be important for particulates, such as lead. Ingestion can occur from eating contaminated food, eating or smoking with contaminated hands, and coughing and then swallowing previously inhaled particulates.
Injection of materials directly into the bloodstream can occur from hypodermic needles inadvertently puncturing the skin of health care workers in hospitals, and from high-velocity projectiles released from high-pressure sources and directly contacting the skin. Airless paint sprayers and hydraulic systems have pressures high enough to puncture the skin and introduce substances directly into the body.
The Walk-Through Inspection
The purpose of the initial survey, called the walk-through inspection, is to systematically gather information to judge whether a potentially hazardous situation exists and whether monitoring is indicated. An occupational hygienist begins the walk-through survey with an opening meeting that can include representatives of management, employees, supervisors, occupational health nurses and union representatives. The occupational hygienist can powerfully impact the success of the survey and any subsequent monitoring initiatives by creating a team of people who communicate openly and honestly with one another and understand the goals and scope of the inspection. Workers must be involved and informed from the beginning to ensure that cooperation, not fear, dominates the investigation.
During the meeting, requests are made for process flow diagrams, plant layout drawings, past environmental inspection reports, production schedules, equipment maintenance schedules, documentation of personal protection programmes, and statistics concerning the number of employees, shifts and health complaints. All hazardous materials used and produced by an operation are identified and quantified. A chemical inventory of products, by-products, intermediates and impurities is assembled and all associated Material Safety Data Sheets are obtained. Equipment maintenance schedules, age and condition are documented because the use of older equipment may result in higher exposures due to the lack of controls.
After a hazard has been recognised and evaluated, the most appropriate interventions (methods of control) for a particular hazard must be determined. Control methods usually fall into three categories:
1. Engineering controls
2. Administrative controls
3. Personal protective equipment.
As with any change in work processes, training must be provided to ensure the success of the changes.
Engineering controls are changes to the process or equipment that reduce or eliminate exposures to an agent. For example, substituting a less toxic chemical in a process or installing exhaust ventilation to remove vapours generated during a process step, are examples of engineering controls. In the case of noise control, installing sound-absorbing materials, building enclosures and installing mufflers on air exhaust outlets are examples of engineering controls. Another type of engineering control might be changing the process itself. An example of this type of control would be removal of one or more degreasing steps in a process that originally required three degreasing steps. By removing the need for the task that produced the exposure, the overall exposure for the worker has been controlled. The advantage of engineering controls is the relatively small involvement of the worker, who can go about the job in a more controlled environment when, for instance, contaminants are automatically removed from the air. Contrast this to the situation where the selected method of control is a respirator to be worn by the worker while performing the task in an “uncontrolled” workplace. In addition to the employer actively installing engineering controls on existing equipment, new equipment can be purchased that contains the controls or other more effective controls. A combination approach has often been effective (i.e., installing some engineering controls now and requiring personal protective equipment until new equipment arrives with more effective controls that will eliminate the need for personal protective equipment). Some common examples of engineering controls are:
The occupational hygienist must be sensitive to the worker’s job tasks and must solicit worker participation when designing or selecting engineering controls. Placing barriers in the workplace, for example, could significantly impair a worker’s ability to perform the job and may encourage “work arounds”. Engineering controls are the most effective methods of reducing exposures. They are also, often, the most expensive. Since engineering controls are effective and expensive it is important to maximize the involvement of the workers in the selection and design of the controls. This should result in a greater likelihood that the controls will reduce exposures.
Administrative controls involve changes in how a worker accomplishes the necessary job tasks—for example, how long they work in an area where exposures occur, or changes in work practices such as improvements in body positioning to reduce exposures. Administrative controls can add to the effectiveness of an intervention but have several drawbacks:
Personal protective equipment consists of devices provided to the worker and required to be worn while performing certain (or all) job tasks. Examples include respirators, chemical goggles, protective gloves and face shields. Personal protective equipment is commonly used in cases where engineering controls have not been effective in controlling the exposure to acceptable levels or where engineering controls have not been found to be feasible (for cost or operational reasons). Personal protective equipment can provide significant protection to workers if worn and used correctly. In the case of respiratory protection, protection factors (ratio of concentration outside the respirator to that inside) can be 1,000 or more for positive-pressure supplied air respirators or ten for half-face air-purifying respirators. Gloves (if selected appropriately) can protect hands for hours from solvents. Goggles can provide effective protection from chemical splashes.
Intervention: Factors to consider
Often a combination of controls is used to reduce the exposures to acceptable levels. Whatever methods are selected, the intervention must reduce the exposure and resulting hazard to an acceptable level. There are, however, many other factors that need to be considered when selecting an intervention. For example: