The flesh is weak
Emmanuelle Brun focuses on the emerging risks to the skin identified by the European Agency for Safety and Health at Work in its recent expert report1 on dangerous substances in the workplace.
Contact with a wide range of hazardous chemical substances at work is endangering the health of workers across Europe. It is estimated that, each year, there are 74,000 work-related deaths linked to hazardous substances encountered in the workplace.
This means that 10 times more people die from dangerous substances than from workplace accidents. About 15 per cent of workers report handling chemical products for around a quarter of their working time, while around 10 per cent report breathing in vapours, and 19 per cent breathing in dust, smoke, fumes, and powders.2
Dangerous substances are found not only in the chemical industry but also in occupations such as farming, nursing, cleaning, construction, and in many small and medium-sized enterprises (SMEs) outside the chemical industry. In a forecast carried out for the European Agency for Health and Safety at Work (EU-OSHA) 49 experts from 21 European countries highlighted five main groups of emerging risks to workers’ health linked to dangerous substances at work, which contribute to diseases ranging from allergies, asthma, and infertility, to cancers.
The expert forecast puts nanoparticles at the top of the list of substances from which workers need protection, under which it also mentioned non-engineered ultrafine particles, dust and aerosols. A second group highlighted in the forecast are carcinogenic, mutagenic and reprotoxic substances, i.e. those that can damage reproductive health. For the purposes of this article, however, I will focus on the third group identified as an emerging risk: allergenic and sensitising substances, such as epoxy resins, isocyanates and detergents.
Dermal exposure is a major route of occupational exposure to dangerous substances. In EU Member States, skin diseases are the second most common occupational disorder, after musculoskeletal problems, and represent between 10 and 40 per cent of recognised occupational diseases.
Contact dermatitis is the most common skin disorder; more than 90 per cent of all occupational skin disorders are hand eczema (allergic and/or irritative contact eczema). Other work-related skin diseases include chemical burns, contact urticaria, photodermatitis, contact leukoderma (vitiligo), infectious dermatitis, and skin cancer.
Chemicals are responsible for 80—90 per cent of skin diseases. The skin of the hands, as well as other body parts, can be affected by indirect exposure to airborne substances, or when contaminated hands touch other body parts (e.g. hand-to-face contact). In the construction industry, chromate is the most important allergen to look out for, followed by epoxy resins and cobalt. Epoxy resins are one of the most widely-used polymeric systems and have become one of the main causes of occupational allergic contact dermatitis. They have many applications and are used in adhesives, sealants, inks, varnishes and reinforced polymer composite structures with glass fibre, carbon fibre or metal substrates, paints and coatings (including protective coatings of canned food).
Natural rubber protein (latex) is another major occupational allergen, particularly in the health-care sector. Soaps, detergents and solvents can also cause dermatitis, as they remove the skin’s surface lipids and dissolve its natural protective barrier. More and more allergic diseases resulting from dermal exposure to fragrances have been observed in recent years among masseurs, physiotherapists and geriatric nurses.
There are no ‘dermal OELs’ (occupational exposure limits). There are two reasons for this: uncertainties in the quantification of the dermal exposure level, and the meagre toxicological data available on health effects from dermal exposure — especially for repeated exposure, exposure to diluted preparations, and combined exposures to various chemicals, or to other factors, such as humidity.
Strength in numbers
The expert report also highlights the growing concern for combined exposures to several dangerous substances. It found that combined exposure to several chemicals in the workplace was the rule rather than the exception, and noted that considering each risk factor independently, rather than in combination, could lead to an underestimation of the real risks to workers.
The experts surveyed emphasised that the effects of mixtures of chemicals are poorly understood and that more research is needed. They warned that a complex mixture of chemicals might have toxic effects on workers’ health even if each compound of the mixture is known to be safe when on its own. If workers are exposed to several substances that act by the same mechanisms, the effects may be additive, or synergetic and damage workers’ health, even if the level of exposure to each substance taken on its own is under the occupational exposure limit.
Combined exposures to mixed chemicals, as well as biological agents, can occur in many occupations, including waste treatment, health care (e.g. exposure to patients’ biological materials and cytostatic agents), cleaning, the metallurgy industry (e.g. metal fumes and gram-negative bacteria contained in aerosols from metalworking fluids), and agriculture (e.g. endotoxins and pesticides).
There is a paucity of epidemiological research available on combined dangerous substances, while toxicological research is still limited to certain types of combined dangerous substances. Some practical tools are available to identify combined exposures in workplaces, such as the job-exposure matrices developed by INRS in France and FIOH in Finland, and a computer-based tool developed by IRSST in Canada. CEFIC (the European Chemical Industry Council) is also developing some guidance for the assessment of risks from preparations, more particularly for solvents.
Changing world of work
Finally, the survey highlights trends related to the evolution of the labour market: the growth in the number of SMEs, the increasing trend towards outsourcing — for example in cleaning and maintenance activities — and the rise in the number of migrant workers, who are generally less well-protected and therefore at higher risk of having their health and/or safety compromised. SMEs employ 66 per cent of the workforce in the European private sector and, in general, their situation in terms of occupational safety and health is worse than larger enterprises. Across the EU, the fatal accident rate in companies with fewer than 50 workers is around double that of larger companies, and 82 per cent of all reported occupational injuries occur in SMEs.
In addition, small firms often experience difficulties in complying with their obligation to assess and control chemical risks in the workplace. In France, for example, the percentage of companies assessing the risks from carcinogenic, mutagenic and reprotoxic substances (CMRs) was shown to increase with the company size: 20 per cent of micro enterprises, 38 per cent of small companies, 57 per cent of medium companies, and 67 per cent of companies with more than 200 workers assessed risks from CMRs.
1 The results of this work are published in the report ‘Expert forecast on emerging chemical risks related to occupational safety and heath’ available free of charge from OSHA’s website — http://osha.europa.eu/en/publications/reports/TE3008390ENC_
2 European Foundation for the Improvement of Living and Working Conditions’ 4th European Working Conditions Survey 2007
Within the scope of its European Campaign 2008-2009 on risk assessment, EU-OSHA has developed useful checklists for risk assessments, as well as a database of risk-assessment tools, all of which are available free of charge on its website: http://osha.europa.eu/en/campaigns/hw2008
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