Hand-arm vibration exposure can cause hand-arm vibration syndrome (HAVS), but it is often overlooked in warm climates where cold temperatures do not trigger attacks. A study conducted awareness training and surveys of employees and contractors at an alumina refinery in Australia over 4 phases to understand prevalence of HAVS-like symptoms. They found 66% of employees using powered tools reported symptoms like tingling and numbness. Management committed to reducing vibration exposure by restricting high-risk tools and sourcing alternatives. Contractors were also encouraged to reduce worker vibration exposure.

1. Acoust Aust (2016) 44:107–112
DOI 10.1007/s40857-015-0033-4
TECHNICAL NOTE
Hand-arm Vibration Exposure in Warm Climates: Promoting
Awareness of Health Effects and Controls to Employees,
Management and Contractors
Rebecca Devine1
Received: 29 September 2015 / Accepted: 4 November 2015 / Published online: 24 November 2015
© Australian Acoustical Society 2015
Abstract Hand-arm vibration exposure is most commonly acknowledged as a major contributor to the presence of vibration
white finger in workers in cool to cold climatic regions. In warmer climatic regions without the cold to trigger the onset of
an attack, hand-arm vibration syndrome is often overlooked and, as such, is suspected to be underdiagnosed in these areas.
By engaging employees in activities such as awareness training, health surveys and monitoring and measuring activities
for exposure times, vibration severity of tooling and effectiveness of anti-vibration gloves, management can demonstrate
commitment to ensuring employee health and employees take ownership of the issues and their resolution. Summarised
professionally and supported with other data such as costs involved with workers’ health claims, rehabilitation, re-training,
back-filling of roles and the like, management can appreciate the full extent of the problem and see that being pro-active about
reducing exposure can be good for business. Contractors can also be brought on the journey by including their tools in the
assessment programme, assisting them to measure their exposure time and supporting them with expert resources to provide
awareness training and health surveys.
Keywords Hand-arm vibration · Anti-vibration gloves · Impact tools · HAVS · Temperature
1 Introduction
The predominant health effect from prolonged exposure to
hand-arm vibration (HAV) is hand-arm vibration syndrome
(HAVS).HAVSisacollectivetermusedtodescribearangeof
vascular (or circulatory) and neurological (both sensory and
motor)disturbancesandmusculoskeletaldisorders[1].There
is substantial evidence to suggest that vascular and neurolog-
ical symptoms of HAVS develop and progress independent
of each other [2–4].
HAVS is a relatively new term for a condition known since
the early 1900s. It was first reported by Loriga in 1911 in
Italian stonemasons, but the earliest clinical description was
by Dr Alice Hamilton in 1918, who examined stone cutters
and carvers at limestone quarries in Bedford, Indiana, USA
[1]. In 1983, a comprehensive study by the National Insti-
B Rebecca Devine
deviner75@gmail.com
1 PO Box 235, Gladstone 4680, Australia
tute for Occupational Safety and Health (NIOSH) concluded
that vibrating hand tools could “cause vibration syndrome, a
condition also known as vibration white finger (VWF) and
as Raynaud’s phenomenon of occupational origin” [5]. They
went on to describe vibration syndrome as having adverse
circulatory and neural effects in the fingers; the signs and
symptoms include numbness, pain and blanching (turning
pale and ashen). Figure 1 illustrates varying degrees of white
finger response in one individual’s hand. Other reported
symptoms include pins and needles (tingling), aches and
pains, stiffness, loss of grip strength, loss of sensitivity, loss
of manual dexterity [6–8] as well as sleep disturbances [6,8].
Operators of tools with impact vibration also report to have
shoulder and neck complaints [8].
It is reported that up to 80–90 % of workers exposed
to HAV will develop some form of vibration-related injury
[9]. The severity of the injury increases significantly in pro-
portion to the number of hours of exposure. Symptoms are
reported to have developed in a little as 2000 h of trigger time
[10].
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2. 108 Acoust Aust (2016) 44:107–112
Fig. 1 Primary Raynaud’s phenomenon (Author’s own hand): capillary over-reaction to a cold stimulus, or vasoconstriction, resulting in ‘white
finger’
There is a vast array of epidemiological research on the
prevalence of HAVS from across the world; however, the
majority of the research has identified and focussed on VWF
symptoms in cooler climatic regions. Yu et al. [11] surveyed
riveters, chippers and grinders in the railroad system of the
People’s Republic of China, Bovenzi [12] investigated Ital-
ian stone workers, Barregard et al. [13] studied mechanics
in Sweden and Sauni et al [14] monitored Finnish metal
workers. One study however reported that forestry workers
in Finland actually had a higher prevalence of neurological
symptoms than vascular [15]. Studies in temperate and trop-
ical regions of the world have discovered that VWF attacks
are less apparent in these areas. These studies included
vibration-exposed workers in Hong Kong [16], miners in
India [17], vibration-exposed workers in Okinawa, a subtrop-
ical area of Japan, [18], quarry workers in Vietnam [19] and
South African gold miners [20]. Until recently, the nature
of the relationship between vibration exposure and VWF
was not fully understood. Current research has identified
that vibration alone does not cause VWF; cold tempera-
tures in combination with vibration exposure is necessary
to trigger the vasospastic response of VWF [21,22] which
appears to explain the findings in the prevalence studies listed
above.
In the UK, HAVS is widely promoted. In 1993, strict legis-
lation mandating the reporting of symptoms saw a significant
increaseinincidence.However,overthepastdecadethenum-
ber of new cases has declined [23]. In contrast, Australia has
a relatively low reported incidence of HAVS. Unlike the UK,
there is very little legislation specific to the reporting and
management of vibration- related injury. It is presumed likely
that the prevalence of HAVS in Australia is underreported.
In 2009, the Australian Safety and Compensation Council
(now Safe Work Australia) commissioned a report on vibra-
tion exposure and vibration control measures in Australian
workplaces in an attempt to understand the extent of the issue
and the relevance of existing guidance material [24]. Issues
around latency of onset of symptoms and willingness to
reportmayberesponsibleforthevariationinthelikelihoodof
young workers (less likely) compared to older workers (more
likely)inmakingcompensationclaims.Itisalsodoubtfulthat
many Australian workplaces manage vibration risk or screen
to identify workers with early HAVS adequately [25] par-
ticularly in small to medium businesses [24]. It is reported
that the knowledge gap in the understanding of the extent of
the issue with vibration exposure in Australian workplaces is
part of the reason why work health and safety organisations
have difficulty in developing specific guidelines and policies
to manage this exposure [24].
In an attempt to fill part of this knowledge gap and deter-
mine the prevalence of HAVS-like symptoms in a temperate
climatic region, a series of awareness raising sessions and
surveys were conducted over a four-year period from 2005
to 2009, in an alumina refinery in Queensland, Australia.
The subsequent journey that continued on for the next three
years resulted in a well-informed workforce and Manage-
ment Team and substantial changes in the workplace to
reduce HAV exposure to protect the current and future work-
force.
2 Methods
The methodology evolved over a series of four phases as the
issue emerged.
Phase 1: Identify ‘at risk’ manual tasks. This process first
revealed HAV exposure existed and the potential presence of
HAVS-like symptoms among employees. The results were
communicated to management with a strategy and recom-
mendations to progress onto Phase 2.
Phase 2: Focus on sources of HAV exposure and the preva-
lence of HAVS-like symptoms. Through a series of employee
awareness training sessions which provided feedback on the
results of Phase 1, employees were informed of the signs
and symptoms of HAVS. This was followed up with a self-
assessment survey where employees indicated if and when
they noticed HAVS-like symptoms. A summary of the results
(to maintain confidentiality) were communicated to manage-
ment with a strategy and recommendations to progress onto
Phase 3.
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3. Acoust Aust (2016) 44:107–112 109
Phase 3: Share learnings and innovations. Through a
two-day exposition and trade show, vendors displayed low-
vibration tooling and ergonomic innovations, while selected
industries presented their own innovations in a series of pre-
sentations.
Phase 4: Standardise. Manage the health of employees
through surveillance checks. Develop procedures on how to
manage residual HAV exposure and put purchasing strategies
in place to ensure only ‘safe’ tooling is brought onto site.
2.1 Phase 1: Identify ‘at risk’ Manual Tasks
The process to identify ‘at risk’ manual tasks was adapted
from the Queensland Workplace Health and Safety Code
of Practice for Manual Tasks 2000 [26]. Since then, the
Queensland Government has published an updated version,
Hazardous manual tasks—Code of Practice 2011 [27]. Both
versions of the code contain material on vibration. The code
follows the general risk management process. There were
four specific activities applied and are described as follows.
Incident data and WorkCover claims: A review of injury
records and WorkCover claims for incidents relating to man-
ual tasks was conducted to determine if there were ‘hot spots’
among the different workgroups that could indicate high
exposure, comparisons and trending over time, costs asso-
ciated with WorkCover claims and common law settlements.
Awareness training and group activity with employees:
At a pre-organised training and development day, employees
were given awareness training on manual task management,
including how to identify manual task risk factors and the
preferred control measures. It concluded with a group activ-
ity where employees were asked to work in small groups to
identify up to five tasks they perform and consider to be most
‘at risk’ and the associated risk factors in each. The worksheet
template provided to each team also asked them to identify
current controls applied to this task to manage those risk
factors and additional controls they would like to see con-
sidering the hierarchy of controls. The main tools identified
in this activity were bolting tools and cleaning tools, includ-
ing impact guns, grinders and rivet busters as illustrated in
Fig. 2. Air drills used for the purpose of operating large valves
also featured in the list.
This activity served a dual purpose, both as an ‘assess-
ment tool’ for the training to test recall and application of
the content presented as well as a data collection tool to
identify a point of focus for management that has been high-
lighted as important to the employees. This activity becomes
a win-win when management commit to fixing the problems
and following through with implementing changes identified
by the employees because management demonstrate to the
employees that they value employee initiatives and are com-
mitted to ensuring a safe and healthy work environment, and
employees feel respected and valued and end up with a safer
workplace.
Body mapping survey: A survey was developed in con-
junction with an Occupational Physician and simply asked
three questions to identify the potential for 1. Carpal tun-
nel syndrome (Do you have numbness and tingling in your
fingers, especially at night?); 2. Epicondylitis (Do you have
persistent pain in the elbow even after days off?); and 3.
Shoulder tendonitis (Do you have pain in the shoulder when
lifting the arm above shoulder height?). This was issued to
workgroups who identified they had a high exposure to ‘at
risk’ manual tasks from the previous activity or identified
through incident data.
Operator Hand-Arm Vibration assessment: A consultant
was engaged to measure the vibration severity of the pow-
ered hand tools identified by the employees. The employees
were involved in the assessment by nominating all the tools
to be measured, and they operated the tools while the mea-
surements were taken so they were able to see how it was
done. Utilising a third party to undertake this work ensured
that it was impartial and without bias, so the employees had
complete trust in the results.
Contractors on site were also invited to have their powered
hand tools measured while the consultant was on site.
The results of these four activities were collated into a
reportthatwaspresentedtomanagementastheirintroduction
to the potential problems with recommendations to progress
onto Phase 2. With well-researched and credible data pre-
Fig. 2 Selection of tools featured in survey results—(L to R)—7” air grinder, 1” drive ‘D’ handle impact wrench, rivet buster used for chipping
silica scale build up from tank internals and pipework
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4. 110 Acoust Aust (2016) 44:107–112
sented in a professional format, it was easy to get the support
of management to progress.
2.2 Phase 2: Focus on Sources of HAV Exposure and the
Prevalence of HAVS-like Symptoms
At the next pre-organised training and development day
(quarterly event), employees were given feedback on the
results of the Phase 1 activities which lead into spe-
cific awareness training on HAV exposure including health
effects,signsandsymptomsandcommoncontrols.Thistime,
the employees were given a self-administered questionnaire
based on the “Protocols For Epidemiological Studies On
Hand Transmitted Vibration Exposure” validated and docu-
mentedbyGriffinandBovenzi [28]. Atotal of 522employees
completed surveys over four days. The questionnaire con-
tained questions about personal identification, social history,
medical history and self-reported HAVS symptoms. The pur-
pose of the questionnaire was to determine which workgroup
had the highest prevalence of symptoms. Workgroups where
greater than 50 % of the workgroup reported symptoms were
followed up with a second, more detailed, questionnaire to
determine occupational history. A selection of 48 of these
workers was randomly chosen to participate in the anti-
vibration glove effectiveness field trials. The benefit of the
questionnaire was that it caused the employees to reflect on
their exposure and how they have potentially been affected.
Employees were informed that the researcher was bound by
ethics approvals and confidentiality and by completing the
survey they were giving their consent for the researcher to
use the information for the purpose of research.
Contractors were offered the expertise of the client Health
and Safety Specialists to provide the same awareness train-
ing sessions and clinical surveys and this offer was accepted
readily by most. Approximately 100 contractors attended
awareness training sessions.
The results from the employee questionnaires were then
collated and a summary reported back to management with
a prediction of the potential claims and associated costs for
treatment of illness. The initial questionnaire revealed that
82 % of workers surveyed use powered hand tools. Fifteen
percent of these workers use vibration dampening gloves.
Sixty-six percent of all workers who use powered hand tools
reported experiencing HAVS-like symptoms such as white
finger (4 %), tingling (48 %), numbness (26 %) both numb-
ness and tingling (25 %) and muscle and joint concerns of
the neck and upper limbs without numbness and tingling
(6 %). Tingling (30 %) and numbness (16 %) were more
often reported after using vibrating tools than in response to
cold (tingling 6 %, numbness 5 %). Overall, sensory neu-
rological symptoms of tingling and numbness or both were
more prevalent than vascular symptoms such as white finger.
Figure 3 illustrates tool usage associated with workers who
Current tool use by workgroups with
HAVS-like symptoms (%)
0
50
100
150
200
250
300
350
Maintenance
Tradespeople
(78%)
Non-trade
Operators
(75%)
Non-trade
Descalers
(68%)
Averageminutesperday
Air Drill
Rivet Buster
Grinders
Impact guns
197
320
211
Fig. 3 Tools and their average daily usage (min/day) associated with
the highest prevalence of symptoms (%) among workgroups who use
them
have reported the highest prevalence of symptoms. Based on
this, management committed to restrict the use of ‘high risk’
tooling, allocate a substantial budget to source alternative
tooling and manage the residual exposure through modi-
fied work practices. This commitment from management was
welcomed when communicated back to the workforce.
Contractor results were also summarised and provided
to management. Through the contract management process,
contractors were encouraged to provide strategies to the
client on how they would reduce their worker exposure to
HAV, particularly during shutdown work. This was embraced
by the contractors, and a great deal of effort was applied to
source the required number of low-vibration bolting tools for
a shutdown and still deliver the required output of work on
time and on budget.
2.3 Phase 3: Share Learnings and Innovations
By this stage, all levels of the organisation have been con-
sulted with or have been involved in at least one part of the
process. The higher the workgroups’ exposure or risk, the
more involved they have been. Many workgroups by now
had realised that changes were required and took the initia-
tive to start their own research to find alternative tooling or
work methods to reduce their exposure to HAV. As momen-
tum increased, it was realised that a coordinated approach to
arranging trials of new tooling and processes was required.
To avoid commercial conflict with vendors and workgroups
going off on their own tangents, management endorsed a pro-
posal to host an Ergonomic Exposition and trade show (Ergo
Expo) where vendors could attend site and demonstrate their
latest low-vibration technology and workgroups could share
their success of their initiatives to date through a series of
presentations and workshops. An invitation was extended to
all local industries to attend to raise awareness in the broader
industrial community.
The Ergo Expo innovations presented included low-
vibration tooling, valve automation trials, hydraulic clamp
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5. Acoust Aust (2016) 44:107–112 111
nut design as well as other more general ergonomic improve-
ments such as conveyor roller change- out techniques,
operation of ship unloaders and modifications to the lab-
oratory layout. Vendor presentations included bolting tool
options, eliminating pinch points and maximising torque
reaction, ergonomic assessment tools, engineering innova-
tion and design in machining, quality control and heat
treatment process, hydraulic tensioning solutions and manual
handling solutions. Vendor displays included various valve
arrangements and seating technology, low-vibration tooling
for bolting, grinding and cleaning, torque tools (hydraulic,
air, electric and electronic), hydraulic breakers, jacking sys-
tems and maintenance tools and a large range of manual
handling equipment and ergonomic office products.
2.4 Phase 4: Standardise
The first aspect of this was to ensure the ongoing manage-
ment of the health of the employees through periodic health
surveillance checks. The next aspect was to develop proce-
dures that define safe work practices, including scheduling of
work and the standard of tooling with regard to permissible
vibration emissions to manage residual exposure. To support
this procedure, the process for the purchase of new powered
hand tools required automatic stop checks in the purchas-
ing system so that only approved tooling can be purchased.
Health data trends can assist in evaluating the effectiveness
of the controls, including compliance to procedures.
3 Discussion
Quite often, experienced Health and Safety Professionals can
review data trends, make observations of workers and iden-
tify issues in the workplace. However, they can struggle to
gain the support and commitment from both the employees
and management when recommending changes to address
the identified issues. The benefit of starting a project with
such a broad approach is that all levels of the organisation
can see the problem present and evolve from the baseline
data. The journey becomes transparent and it is the data that
dictates the direction. It is no longer seen as just the personal
agenda of the “Safety Department”.
This method, whilst drawn out, was very effective because
it was a process over time and offered so many opportunities
for involvement and consultation, and it got the “buy in” from
those who had the most to gain from the results.
However, there is a limitation. Without specific legisla-
tive guidelines on the expectations for managing exposure to
HAV in the workplace, the results of this work will have a
limited lifespan. The corporate memory of the history and the
importance of how and why the site-specific procedures and
rules around managing HAV exposure came to be will fade
with employee and management turnover. So long as controls
implementednowremaineffectiveinthefuture,therewillnot
be the health data indicating a problem with HAV exposure
because it is being managed. Because it is managed, the need
to provide awareness training will not seem as important.
Eventually, it will be asked why there are such strict controls
around the purchase of powered hand tools and there is a real
risk that this will be relaxed. To avoid the loss of corporate
memory, it is necessary to document results, findings, busi-
ness cases and recommendations including decisions made
and why as part of a management of change process or in a
risk register. This needs to be referenced in the relevant pro-
cedures to inform the future generation of decision makers.
4 Conclusion
It is suspected that the prevalence of HAVS in Australia is
underreported. By informing both employees and manage-
ment about the health effects and sources of exposure in the
workplace through awareness training and self-assessment
questionnaires, the resulting data can be used to inform and
then direct the required decisions to ensure that the most
appropriate controls are introduced. Involving the employees
and management in every step of the data gathering process,
the direction becomes transparent and self-evident.
Where legislation does not exist to ensure the ongoing
management of HAV exposure, corporate memory can be
maintained over time by keeping accurate records of results,
business cases and recommendations in a risk register and
references to this data in company procedures and standards.
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