An Occupational Health And Safety Management System Approach To Addressing Sun Safety - Ohnans Presentation, By Brenda M - November 18, 2016

1. Sun Safety at Work Canada
AN OCCUPATIONAL HEALTH AND SAFETY
MANAGEMENT SYSTEM APPROACH TO
ADDRESSING SUN SAFETY
Brenda M Marsh, RN, COHN(C), CRSP, CHSC
Occupational Health Nurses Association of Nova Scotia
Nov 18, 2016

2. What is Sun Safety?
• Measures taken by a workplace to manage outdoor
worker exposure to the sun, and help prevent:
– Adverse eye and skin conditions from over-exposure
to solar UV radiation (e.g. skin cancer, photokeratitis)
– Heat-related conditions from heat-stress associated
with exposure to the sun in combination with physical
activity or outdoor work

3. Project Design
Interviews,
Worker
surveys,
document
analysis,
observation
Baseline Eval
“Action Plans”
– workplaces
planned what
they would do
Maintain
contact,
provide
assistance
Refine &
implement
initiatives
Interviews,
Worker & OHS
Lead surveys,
UV dosimetry
Final Eval
Re-engage,
OHS &
Management
interviews
Midpoint Eval
https://sunsaf
etyatwork.ca/a
bout-us
Winter 2016
Summer
2015
Spring/
Summer
2015
Fall 2016Summer 2016Spring 2016
Municipalities
Electrical Utilities
University
British
Columbia
Ontario
Nova Scotia

4. SSAWC Project Overview
2014 2015 2016
Phase I: Workplace Trial
• Develop, implement, and improve
sun safety programs at trial sites
Phase II:
Broader Reach
• Develop the website
• Engage intensively with stakeholders
T2T1
Action Plan Final
Phase I Evaluation T3
Workplace Reports Baseline

5. Occupational Sun Exposure
• # Outdoor workers in Canada: 1.5M(8.8%)
(CAREX Canada, 2012) to 5.4M (26%) (Marrett et al, 2010)
• When assessed, outdoor work exposures
are often many times the TLV/OEL
• Canada – Levels of Exposure: (Peters etal, 2012)
– Low: almost never exposed – truck &
delivery drivers
– Moderate: indoor/outdoor mix – crane
operators, carpenters, maintenance
labourers, couriers
– High: >75% outside – farmers,
construction
(OCRC & CAREX, 2016)

6. Occupational Sun Exposure & Skin Cancer
Canadian Burden of Occupational Cancer Project:
• 4560 non-melanoma skin cancers each year attributed
to occupational solar radiation
Comparison:
• Asbestos: 1900 lung cancers
& 430 mesotheliomas
• Diesel engine exhaust: 560
lung cancers & 200 suspected
bladder cancers
• Crystalline silica: 570 lung
cancers
(OCRC & CAREX, 2016)

7. Occupational Sun Exposure & Heat Stress
• Heat stress is a spectrum of
disorders that can occur because of
sun exposure, heat, and physical
activity (CDC, 2013)
• Most serious form is heat stroke,
which as irreversibly damage the
heat, kidney, and liver, and can
result in death (Chao et al., 1981)
• Heat stress is more common in
outdoor workers (CDC, 2008)
• Solar radiation is the primary
source of heat stress for outdoor
workers (Ontario Ministry of Labour, 2012)
Image provided by Queensland Department of Health

8. Sunburn
• Damage to the genetic material in your skin
• Sunburn once every 2 years can triple the risk of melanoma
• Swelling, as blood rushes to the surface, tries to rehydrate,
immune system fights back releasing painful chemicals

9. Sun Safety Programs
• Apart from Be Sunsible in AB (www.besunsible.ca),
there are no occupational sun safety programs
delivered in Canada
• ‘Interventions in outdoor occupational settings to
prevent skin cancer’ are ‘recommended’ based on
‘strong evidence of effectiveness in increasing
outdoor workers’ sun protective behaviors and
reducing sunburns’ (Community Preventive Services Taskforce, 2013)
• There are no occupational sun safety programs in
Canada that address both skin cancer and heat
stress or embed sun safety within an OHSMS →
Sun Safety at Work Canada

10. Sun Safety Programs – our approach
• Workplaces should consider sun exposure like any
other workplace hazard and manage it the same way
as other hazards, i.e. through an OHSMS
• For workplaces with outdoor workers, a Sun Safety
Program (SSP) should be part of an organization’s
OSHMS.
• The SSP is focused on prevention and management of
health risks associated with sun exposure within the
workplace.
• OHSMS is based on the Plan-Do-Check-Act model of
improvement

11. Model Sun Safety Program
Sun Safety ‘Lens’
• Sun Safety Elements?
• Solar UV Exposure?
• Heat Stress?

12. Primary Prevention
• Coach your employees re: the harmful effects of solar
radiation on their skin, eyes and immune system and
how to avoid them.
• Educate them re: control measures.
–Reduce the risk by approximately by 45%.
–Lessen the need for surgery, pain, disfigurement
–Improve health of EEs
–Decrease time away from work
–Maintenance of productivity levels
–Lower costs to health benefit program
–Lower costs to health care system

13. Three (of 200) Forms of Skin
Cancer
• 50 Nova Scotians per week diagnosed skin cancer
• Basal cell carcinoma (BCC) non-melanoma
• Squamous cell carcinoma (SCC) non-melanoma
• Melanoma – the deadliest form

14. ? Most Common Type of
Cancer?
• Skin cancer - 73,000 new cases of cancer in 2008
–4,600 cases of melanoma skin cancer
–73,000 cases of non melanoma skin cancer (2,360
NS)
• Rates are increasing
• Nova Scotia & PEI - highest rates in the country

15. Skin Cancer Risks
• You Cannot Change
• fair skin that tans poorly or burns
• blonde, red or light brown hair
• light coloured eyes - blue, grey, or green
• freckle easily
• large number of moles
• family history of skin cancer
• A tendency to burn rather than tan
• You CAN Change
• repeated sunburns
• work outdoors
• outdoor activities
• use of tanning beds
• sun bathing
• prolonged exposure to the sun

16. Increase in Skin Cancer – Why?
• Changes in ozone layer
• Involvement in outdoor activities
• Modern clothing exposes more skin
• Decreasing amounts of stratospheric ozone which
partially protects the earth's surface from receiving
cancer-producing ultraviolet (UV) radiation
• People are moving to sunnier locales
• General aging of the population
• Tanning the skin is falsely viewed as healthy
• Need Vitamin D

17. UV Rays: Short Term Effects - EYES
• Some industrial chemicals can cause photosensitisation of the
eyes (some coal tar derivatives) can damage the outer surface
of the eye.

18. Skin Cancer Causes
• 90% melanomas - UV radiation
Other causes
• Chemical exposure

19. Types of Radiation
• Visible light, which gives us the colours we see,
• Infrared radiation which gives us the warmth we feel, and
• Ultraviolet (UV) radiation.
• UV radiation can cause harmful effects to the skin
There are three basic types of ultraviolet radiation:
• UVA (long-wave UV),
• UVB (sunburn UV), and
• UVC (short-wave UV).

20. Artificial Sources of UV Radiation
• Electric and plasma arc welding and cutting tools
• Gas or vapour pressure discharge lamps used in lighting,
curing paint, inks
• Bacterial and fungicidal cabinets and lamps
• Solariums and ultraviolet lamps
• Some molten metal presses

21. PHOTOSENSITISING SUBSTANCES
• Exposure to photosensitising substances can worsen the
effects of solar UV radiation
• Ex: coal tar and several of its by-products,
• certain dyes, selected plants and fruits
• a number of medications (tetracyclines, sulfonamides,
thiazide diuretics, chlorpromazine, oral contraceptives)

22. UV Rays: Long Term Effects - EYES
• Damage to the cornea
• Cataracts - opacities of the lens of the eye

23. Pterygia
• Wing-shaped growths of the tissue on the outside of the eye,
can grow over the cornea

24. Immune Suppression
• Overexposure to UV radiation may suppress proper
functioning of the body's immune system and the
skin's natural defenses.
• All people, regardless of skin color, might be
vulnerable to effects including impaired response to
immunizations, increased sensitivity to sunlight, and
reactions to certain medications.

25. Canada’s Food Guide
• “In addition to following Canada's Food Guide, men and
women over the age of 50 should take a daily vitamin D
supplement of 10 µg (400 IU)”
• Deficiency results in impaired bone mineralization, and leads
to bone softening diseases, rickets in children and
osteomalacia in adults, and contributes to osteoporosis.

26. Canada - Males Working Outdoors
• 44% seek shade during recreation/38% at work
• Only 23% report wearing sunscreen on their face
• Only 21% said that their employers were sources of
information about sun safety
• Most reported that they obtained information from
television, magazines, family, and friends

27. Legal Requirements for
Protection
Nova Scotia
• Sun Safety Law for Nova Scotia Fact Sheet

28. Building a Sun Safety Program
Set-Up
• Buy-in
• Lead /
work
group
Review
Current
Practice
•Assess &
compare
with Model
SSP
‘elements’
Action
Plan
•Identify
‘elements’ for
action
•Prioritize &
Timeline
•Resources
•Responsibility
Implement
•Implement
actions as
per Action
Plan
Review
•Periodically
review Action
Plan and
actions
implemented
•Evaluate
effectiveness
Continual Improvement
Build Your Own Sun Safety Program

29. Total exposure to solar UVR during
outdoor jobs depends on
• the geographical location of the job
• the time of year when outdoor work occurs
• the times of the day when outdoor work occurs
• the pattern and length of exposure – total amount of
exposure over the day
• the availability and use of control measures
• work tasks and/or breaks where exposure occur
• the presence of reflective surfaces
• the presence of photosensitisers
• existing sun protection available

30. Season, Latitude & Altitudes
• The time of the year and the latitude of where you are
working
• UV Ray levels - more intense during the summer months and
the closer you are the to the equator
• Altitude - the intensity of UV radiation increases around 4%
with every 300m rise above sea level

31. Reflective Surfaces
• UV radiation can reflect from surfaces
• Shiny materials, light coloured concrete and paintwork,
reflective building glass, corrugated steel, aluminum roofing,
sand, water, some soils and even grass

32. Office Building Glass
• less than 1% of solar UVR will pass through
• the window absorbs the remaining 99%

33. UV Radiation & Glass
• Vehicle glass offers some protection from UV radiation
• The levels of solar UVR inside a car vary, (side windows
are open or closed or orientation of the vehicle with
respect to the sun)
• Plain window glass used in car side windows provides
only moderate protection unless clear or tinted film is
applied
• Laminated windscreens, made of a tough plastic layer
bonded between two panes of glass
• When UV levels are 3 and above - use sun protection in
vehicles. This will ensure occupants are protected both
in the vehicle and when they leave it.

34. SUN SAFE CONTROL MEASURES
• Engineering controls (reduce exposure to solar UVR by a
physical change to the work environment)
• Administrative controls (reduce exposure to solar UVR by a
change in work procedure and the way work is organized)
• Personal protective equipment and clothing (reduce exposure
to solar UVR by providing a personal barrier between
individual workers and the hazard)

35. Engineering Controls
• Providing shade from direct sunlight or relocating tasks to
shaded areas
• Increase the amount of shade provided:
- carry out work in the shade of trees or buildings
- move jobs to shaded areas
- use portable shade
- erect permanent shade structures

36. Engineering Controls
• Shade examples
•Trees
•Umbrellas
•Canopies
•Gazebos
•Awnings
•Sailcloth
•Shade from Buildings

37. Engineering Controls
• Note:
A high degree of attenuation of solar UV radiation
can be achieved with ordinary window glass
• Keep vehicle windows up when driving for long
periods (tint car glass and window glass for
protection against solar)

38. UVI Category & Sun Protection
Message

39. Administrative Controls
• Establish a system for employees to receive a daily text
message reminder of the UV Alert
• Set up a Sun Smart UV Alert sign at key worksite
entrance/exit points/bulletin boards
• Change the sign daily to reflect the current forecast
• Plan work schedules based on the UV Alert

40. Administrative Controls
• Reschedule work (before 11 am & after 4 pm)
• Alternate employees between indoor & outdoor tasks
• Plan work routines so indoor or shaded work tasks are done
during the middle of the day
• Environment Canada UV ratings for the day:
• http://www.msc-smc.ec.gc.ca/topics/uv/

41. PPE Tips for Success
• Set an example. Ensure managers and supervisors
model the policy & program.
• Educate employees in the use of sun protective PPE
(dispel misconceptions about the use of sun protection –
see CDA quiz)
• Ensure your workers are aware of all the sun protection
control measures and the importance of using each in
combination, wherever possible.

42. Text-Message Reminders to
Improve Sunscreen Use
• A Randomized, Controlled Trial Using Electronic
Monitoring
Arch Dermatol. 2009;145(11):1230-1236.
• To evaluate the effectiveness of cellular telephone text
messaging as a reminder tool for improving adherence
to sunscreen application.
• Participants who received daily text-message reminders
had a mean daily adherence rate of 56.1%.
• Participants who did not receive reminders had a mean
daily adherence rate of 30.0%.

43. Personal Protective Equipment &
Clothing
• Sun protective work clothing
• Sun protective hats
• Sunglasses
• Sunscreen

44. Sun Protection Factor
• SPF refers to the ability of the product (e.g. sunscreen or
clothing) to protect skin from UVB rays
• The higher the SPF rating the more protection (SPF 30
provides more protection than SPF 2)

45. PPE & Clothing - Barriers
• Inconvenient, sticky, smelly
• Forgot
• Wanted to get a tan
• Too hot to wear personal protective clothing
• Men less likely to wear sunscreen

46. S P F
0
20
40
60
80
100
%HarmfulUVBRays
Filtered
2 4 8 10 15 25 30
Sun Protection Factor
SPF

47. PPE & Clothing
• Recognized Sunscreens
http://www.dermatology.ca/programs-resources/programs/recognized-
products/#!/programs-resources/programs/recognized-
products/sunscreens/
• Check the EXPIRY date!

48. PPE & Clothing
Sunscreen
• Use with other sun protection
• No sunscreen offers 100% protection from solar UVR
• Apply 30 minutes before going outdoors (so that it can
be absorbed into the skin properly)
• Second application 20 minutes later will maximize the
protection
• Reapply every two hours, or more often if perspiring
• Cover all exposed areas, especially neck, ears,
forehead, nose and hands.
• Minimum 30 ml of sunscreen for one full body application

49. PPE & Clothing
Sunscreen
• Should be kept in easily accessible places
• Store in a cool place below 30° C
• Sunscreen can be bought as a cream, lotion, milk or
gel - avoid aerosols
• Apply sunscreen on cloudy days & in winter
• Lips also need to be protected - lip balm containing
SPF 30+
• Apply sunscreen before insect repellant (as the
repellant may reduce the effectiveness of sunscreen)

50. PPE & Clothing
Sun protective work clothing
• Wear clothing that covers as much of the body as
possible
• Fabrics that don't let light through work best
• Make sure clothing is loose and comfortable

51. PPE & Clothing
Sun protective hats
• Wear a wide-brimmed (4 inch) hat
(not a cap)
• Attach a back flap to construction headwear to cover the
back of the neck

52. PPE & Clothing
Sunglasses
• UVA and UVB American National Standards Institute
(ANSI) Standard Z87.1
• CSA Z94.5-95 Nonprescription Sunglasses
• Close-fitting, wrap around style sunglasses
• Polarized lenses reduce reflected glare
• Safety sunglasses
• Fit-overs for prescription glasses

53. PPE & Clothing
Sunglasses
• Where colour or traffic signal recognition is a necessary
requirement of work duties, or where colour distortion could
adversely affect the safety and/or health of an employee -
ANSI Standard Z80.3, CAN/CSA-Z94.3-99
• Neck retainers

54. PPE & Clothing
Sunglasses
• Plastic lenses – look for scratch resistant coating
• Check distortion – put on sunglasses, look at a
rectangle pattern (i.e. floor tiles). If lines stay straight
when you move your head up and down and side to
side, then the amount of distortion is acceptable.

55. PPE & Clothing
Sunglasses – Types of Lenses
• Regular lenses - reduce brightness of everything
• Polarizing lenses: designed to cut glare due to
reflection. Use for driving & outdoor activities (snow
or on water)
• Photochromic lenses - change intensity of UV light
(turn darker outdoors, lighter indoors). If used for
driving, select fairly dark lenses.
• Flash or mirror lenses - reflect all or part of light
instead of absorbing it. No performance advantage,
scratch easily.

56. PPE & Clothing
Sunglasses - 3 Industry Standards
• Cosmetic – lightly tinted, not for use in harsh
sunlight. Block 0 – 60 % visible light & UVA rays,
87.5% - 95% UVB rays. Use daytime driving.
• General Purpose – block 60 – 92% visible light & UVA
rays & 95 – 99% UVB rays. Use driving & harsh
sunlight.
• Special Purpose – Block 97% visible light & 98.5%
UVA rays & 99% UVB rays. Suitable for prolonged
sun exposure & not for driving.

57. PPE Tips for Success
• Involve employees in selecting suitable sun protective
clothing & hats, sunglasses & sunscreen.
• Select a supplier who is able to respond to the needs of your
employees and design/develop new sun protective products.
• Trial new initiatives – samples. Document their feedback,
concerns, complaints.

58. Catchy Slogans
• Protect the skin you’re in
• When outside, protect your hide
• Slip, Slap, Slop
• Pool Cool
• Save your hide, when outside
• Go Sun Smart
• Sunwise
• Keep Your top on
• Know your Moles

59. Atlantic Canadians Artificial Tanning
(2008) 11% used artificial tanning equipment, which is similar
to the Canadian average of 9%
Females were more likely to have used artificial tanning
equipment in the past year than males
• Males - 7%
• Females – 15%
Use of artificial tanning equipment - most prevalent among
younger adults and declines with age
• 16-24 year olds – 23%
• 25-44 year olds – 15%
• 45-64 year olds – 7%
• Dear Sixteen Year Old Me

60. Secondary Prevention
• Early recognition of damage to enable them to access
the healthcare system as soon as possible to deter the
disease process.
• Short Term Effects: Photoconjunctivitis (inflammation of
the conjunctiva), Photokeratitis (inflammation of the
cornea); are due to the accumulation of photosensitive
compounds beneath the skin.
• Painful sensation in the eyes, excessive blinking and
tears, the sensation of a foreign body in the eyes,
difficulty in looking at strong lights, and swelling of the
eyes. Appear within a few hours & often disappear within
2 days.

61. What is Skin Cancer?
• Abnormal cells
• Unregulated growth
• Ability to spread from the skin to other parts of
our body
• What can it look like?
• A mole
• A sore that doesn’t heal
• A lesion

62. Abnormal Skin Changes

63. Abnormal Skin Changes

64. Abnormal Skin Changes

65. Taking Action
Know:
• your family history
• the risk factors for skin cancer
• your own skin

66. Report any concerns
to your doctor
Early detection is critical

67. M = Moles
R = Red hair and freckling
I = Inability to tan
S = Severe sunburn
K = Kin
Risk Factors for Skin Cancer

68. Taking Action
Know:
• your family history
• the risk factors for skin cancer
• your own skin

69. Know your skin: Watch for…
• a new growth
• sores or lesions that don’t heal
• any changes in a birthmark or a mole

70. Know your ABCDE’s
• Asymmetry
• Border irregularity
• Colour variation
• Diameter
• Evolution

71. Asymmetry
A
www.dermatology.ca

72. Border
B
www.dermatology.ca

73. Colour
C
www.dermatology.ca

74. Diameter
D
www.dermatology.ca

75. Evolution
E
www.melanomafoundation.com.au

76. Tertiary Prevention
• Return to work
• Modified hours
• Modified duties
• May be restricted to working outdoors during specified hours
• Will need time for follow up medical appointments
• Allow those, who has been treated for disease related to solar
radiation, to return to work, accommodating for continuing
treatment and modifying duties.
• Residual long term effects are damage to the cornea,
cataracts.

77. Tools & Resources – SSaWC Examples…
SSP Element SSaWC Tool or Resource
Sun safety policy Fact sheet; Example policies for heat stress, solar UV, and
sun safety, for small & large workplaces; Policy checklist
Responsibility,
accountability, authority
Example roles & responsibilities – solar UV, heat stress
Legal & other
requirements
Fact sheets – general legal issues, plus fact sheets for each
Province
Sun safety risk
assessment
Solar UV: risk assessment technical guide; operational
review; daily procedure
Heat Stress: risk assessment technical guide; operational
review; daily assessment; daily monitoring plan
Control measures Fact sheets – personal protection, shade, vehicle windows,
Sun safe job procedures UV Index poster; Heat stress alert poster; Heat stress
warning poster; Fact sheets – acclimatization, work/rest
cycles

78. Tools & Resources – SSaWC Examples…
SSP Element SSaWC Tool or Resource
Sun safety training
& education
Posters – solar UV, heat stress; Fact sheets – UV
prevention, photosensitizing substances, heat
stress prevention, heat stress signs & symptoms;
Presentations for workers & supervisors – heat
stress & solar UV; Personal risk assessments – UV
& heat stress; Toolbox talks – solar UV & heat
stress; Videos
Inspections Inspection checklist & report
Incidents Incident Report
Off-the-job sun
safety
Fact sheet; website with links to self-screening,
quizzes, kids activities, etc.
All resources available at our website: www.sunsafetyatwork.ca

79. Review Your Sun Safe Program
When…
• changes in a work procedure which may lead to greater solar
UV radiation exposure
• requests/recommendations are received from OHS
committees
• conditions associated with a hazard change
• new hazard information is received
• needs identified in the annual review of accidents,
incidents, inspections, hazardous occurrence
investigation reports, OHS audits, and first aid records,
• work practices change
• equipment is changed or new equipment is introduced

80. Effective Sun Safety Programs
Individual + Organizational Active engagement Customizable
EmbeddedWorkplace champion Management support

81. Thank you!
Production of this presentation has been made possible through financial support
from Health Canada through the Canadian Partnership Against Cancer.
Thank you to all of the partners who made this project a success: