INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.orgPractical steps to controlexposure to workplacecarcin...
Plan for the workshop…• Introduction (25 mins)• Four agents(15 mins each)• Crystalline silica• Shift work involving night ...
We know what to do…• Minimise emission, release and spread of substances• Take into account all relevant routes of exposur...
Control of exposure…• Elimination• Substitution• Process modification• Ventilation• Isolation or segregation• Maintenance•...
Control of exposure…• Elimination• Substitution• Ventilation and control at source• Education and training• Personal prote...
Substitution…• Successes• Bladder cancer in the rubber industry andβ-naphthylamine• Toluene for benzene• However, substitu...
ECEL…• ECEL = Exposure Control Efficacy Library• Review of literature on the effectiveness ofenclosures, local ventilation...
ECEL4/24/2013OH2013 - Workplace Carcinogens 8Fransman et al. Development and Evaluation of an Exposure Control Efficacy Li...
ECEL…Risk Management Measure n Estimatedefficacy(%)95% confidenceintervalLEV in general 280 82 78 to 84LEV + enclosure 9 8...
Assigned ProtectionFactors4/24/2013OH2013 - Workplace Carcinogens 10
Nicas M, Neuhaus J. Variabilityin Respiratory Protection andthe Assigned Protection Factor.J Occup Environ Med2004;1:99–10...
Effectiveness ofbehavioural interventions• Results from a systematic review• 550 potentially relevant articles identified•...
Control of exposure…• Elimination• Does what it says on the tin!• Personal protective equipment• Highly effective if you c...
How do you get peopleto act?• Introduce new OELs?• Provide free guidance material?• Offer compliance support for organisat...
Crystalline silica…• IARC 1 – lung cancer• 5.3m exposed in Europe (4m in construction)• Movement of earth (e.g. mining, qu...
Shift work…• IARC 2a – female breast cancer• Perhaps 25,000 cases each year in Europe due toshift working• 15 – 20% worker...
Diesel engine exhaust…• IARC 1 – lung cancer and bladder cancer• 3.6m people exposed in Europe• Mining and quarrying• Cons...
Hardwood dust…• IARC 1 – sinonasal and nasopharyngeal cancer• 3m people exposed in Europe• Manufacture wood products• Join...
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Control of exposure to workplace carcinogens - introduction to a workshop

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This is the introductory talk for a workshop session I gave at the British Occupational Hygiene Society (BOHS) conference in Manchester, OH2013.

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Control of exposure to workplace carcinogens - introduction to a workshop

  1. 1. INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.orgPractical steps to controlexposure to workplacecarcinogensJohn Cherrie
  2. 2. Plan for the workshop…• Introduction (25 mins)• Four agents(15 mins each)• Crystalline silica• Shift work involving night work• Diesel engine exhaust• Hardwood dust• Final discussion (5 mins)I hope that we can write a short article for theBOHS Exposure newsletter?4/24/2013OH2013 - Workplace Carcinogens 2
  3. 3. We know what to do…• Minimise emission, release and spread of substances• Take into account all relevant routes of exposure• Control exposure by measures that areproportionate to the health risk• Choose the most effective and reliable controloptions• Where needed provide suitable personal protectiveequipment• Review regularly all elements of controls• Inform and train all employees• Ensure control measures do not increase overall risk4/24/2013OH2013 - Workplace Carcinogens 3http://www.hse.gov.uk/coshh/detail/goodpractice.htm
  4. 4. Control of exposure…• Elimination• Substitution• Process modification• Ventilation• Isolation or segregation• Maintenance• Education and training• Personal protective equipment4/24/2013OH2013 - Workplace Carcinogens 4
  5. 5. Control of exposure…• Elimination• Substitution• Ventilation and control at source• Education and training• Personal protective equipment4/24/2013OH2013 - Workplace Carcinogens 5
  6. 6. Substitution…• Successes• Bladder cancer in the rubber industry andβ-naphthylamine• Toluene for benzene• However, substitutions are complex and mayhave unexpected consequences• use of citrus oil rather than trichloroethylene, but…• d-limonene when oxidized presents risks as a skinallergen• Registries can promote substitution• Plus, you have to get organisations to do it!4/24/2013OH2013 - Workplace Carcinogens 6
  7. 7. ECEL…• ECEL = Exposure Control Efficacy Library• Review of literature on the effectiveness ofenclosures, local ventilation and other controls atsource• 90 peer-reviewed papers• Wide variation in effectiveness• The data published since the ECEL report wasprepared broadly supports the original analysis• Effectiveness in experimental or semi-experimentalstudies higher than other situations4/24/2013OH2013 - Workplace Carcinogens 7Fransman et al. Development and Evaluation of an Exposure Control Efficacy Library(ECEL). Annals of Occupational Hygiene (2008) vol. 52 (7) pp. 567-575.
  8. 8. ECEL4/24/2013OH2013 - Workplace Carcinogens 8Fransman et al. Development and Evaluation of an Exposure Control Efficacy Library (ECEL). Annals of Occupational Hygiene(2008) vol. 52 (7) pp. 567-575
  9. 9. ECEL…Risk Management Measure n Estimatedefficacy(%)95% confidenceintervalLEV in general 280 82 78 to 84LEV + enclosure 9 86 69 to 94Integrated 133 87 84 to 90Mobile 4 61 -28 to 88General ventilation 42 43 17 to 614/24/2013OH2013 - Workplace Carcinogens 9
  10. 10. Assigned ProtectionFactors4/24/2013OH2013 - Workplace Carcinogens 10
  11. 11. Nicas M, Neuhaus J. Variabilityin Respiratory Protection andthe Assigned Protection Factor.J Occup Environ Med2004;1:99–109.Effectiveness ofrepiratory protection…4/24/2013OH2013 - Workplace Carcinogens 11
  12. 12. Effectiveness ofbehavioural interventions• Results from a systematic review• 550 potentially relevant articles identified• 10 were considered informative• Behavioural interventions had a limitedpositive impact upon exposure• It’s not sufficient to just raise awareness ofrisks and controls, need to equip workerswith skills to act on that knowledge4/24/2013OH2013 - Workplace Carcinogens 12Lunt JA, Sheffield D, Bell N, et al. (2011) Review of preventative behavioural interventions for dermal andrespiratory hazards. Occup Med (Lond);61:311–20.
  13. 13. Control of exposure…• Elimination• Does what it says on the tin!• Personal protective equipment• Highly effective if you can get good compliance• Substitution• Potentially effective, but may be difficult to achieve inpractice• Ventilation and control at source• Very variable effectiveness, between locations• Education and training• No appreciable effect4/24/2013OH2013 - Workplace Carcinogens 13
  14. 14. How do you get peopleto act?• Introduce new OELs?• Provide free guidance material?• Offer compliance support for organisations?• Develop cost-effective technologies?• Offer financial support to SMEs to introduce newtechnology?• Strictly enforce the law, e.g. COSHH?• Require the introduction of new technology?• Ban the use of the agent?• Or something else.4/24/2013OH2013 - Workplace Carcinogens 14
  15. 15. Crystalline silica…• IARC 1 – lung cancer• 5.3m exposed in Europe (4m in construction)• Movement of earth (e.g. mining, quarrying, tunnelling)• Crushing or grinding of silica containing material such asconcrete, aggregate or mortar• Sandblasting• Use of silica, sand or silica containing products in themanufacture of glass and other non-metallic mineralproducts• Use of sand in foundries• Geometric mean exposure 0.07 mg/m3 with a GSDof about 5 (i.e. about 50% exceed 0.05 mg/m3).• Maybe 7,000 deaths per year from past exposure• OELs: mostly between 0.05 and 0.1mg/m34/24/2013OH2013 - Workplace Carcinogens 15
  16. 16. Shift work…• IARC 2a – female breast cancer• Perhaps 25,000 cases each year in Europe due toshift working• 15 – 20% workers work nights• Health• Machine ops• Hotels, catering etc.• Transport• Wholesale• No OELs, but risk highest for after midnight androtating night shift, particularly >500 shifts inlifetime4/24/2013OH2013 - Workplace Carcinogens 16
  17. 17. Diesel engine exhaust…• IARC 1 – lung cancer and bladder cancer• 3.6m people exposed in Europe• Mining and quarrying• Construction• Transport• 4,500 deaths per year in Europe• Geometric mean exposure levels: 0.06 mg/m3 inmining, 0.014 mg/m3 in transport (GSD about 3)• Very few countries with OELs. Typical valuesaround 0.1 mg/m3, but a “safe” limit would bearound 0.01 mg/m34/24/2013OH2013 - Workplace Carcinogens 17
  18. 18. Hardwood dust…• IARC 1 – sinonasal and nasopharyngeal cancer• 3m people exposed in Europe• Manufacture wood products• Joinery• Boat building• About 160 deaths per year• Geometric mean exposure in boat buildingabout 2 mg/m3 and otherwise about0.5 mg/m3 (GSD 4)• OELs between 1 and 5 mg/m34/24/2013OH2013 - Workplace Carcinogens 18

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