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July 2, 2013

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Food industry – What’s cooking?

The food industry presents many of the same health and safety challenges as any other sector but it also has some very specific conundrums, as Dr Chris Ide points out.

Prawn-induced asthma, anyone?

I suppose the need for a food industry started to arise after the Industrial Revolution. Prior to that, in the subsistence agriculture system that prevailed up to that time, most food was produced in small amounts and consumed locally.

This was partly because the raw materials were often bulky, and thus difficult to transport over any great distance because of the poor roads of the time.

However, the concentration of population in the towns, together with the improvements in transport initially started by the canals, then followed by the railways, and aided by the increase in capital available meant that large-scale manufacturing of food products became more feasible. And, of course, the railways and canals facilitated the distribution of the industry’s products.

In the UK, the food industry today employs about 14 per cent of the working population.1 It is dominated by large multinationals but, over the past few decades, there has been a resurgence in ‘artisan’ production, driven by a variety of factors, ranging from a desire to assert individualism to a belief in the superiority of the product.    

Whether large or small, all food producers need raw materials, which are mostly derived from animals or plants. Some of the hazards involved with this aspect of food production have been described in previous articles.2,3 Once the raw materials have arrived at the manufacturing premises, the manufacture of the food product can be divided into four general stages — handling and storage, extraction, processing and conservation.4

According to the HSE,5 the principal contributors to occupational ill health in the food (and drink) industries are musculoskeletal injuries, (including back and upper-limb injuries), work-related stress, occupational respiratory disease (asthma and rhinitis — runny nose), dermatitis and noise-induced hearing loss. In some ways, these rankings differ little from those in other industrial sectors, and the triggers may also be similar.

Although some cases of occupational disease are notified via RIDDOR, most of the data about work-related ill health is derived from sources such as THOR — the Health and Occupation Research network, based at the University of Manchester and comprising specialist occupational-health physicians and GPs with an interest in occupational medicine, who report possible cases of work-related disease seen in patients in their practice.

Musculoskeletal problems

The most common musculoskeletal disorders are low back pain and work-related upper-limb disorders (WRULDs). Low back pain can be triggered by a variety of factors, not just by lifting heavy weights. WRULDs can affect any part of the upper limb — from the neck and shoulder to the tips of the fingers — and can involve a number of symptoms, such as pain, weakness, parasthesiae (pins and needles) and numbness.

There are a few specific diagnoses, such as tenosynovitis, carpal tunnel syndrome, tennis and golfer’s elbow, but I would respectfully suggest that safety advisors do not try to make for themselves specific diagnoses (although employees may say, or present medical certificates to the effect that they have been diagnosed with a particular disorder. This may have implications regarding notification of the HSE/Local Authority under RIDDOR 1995).

The approaches suggested by McKeown6 in the chapters on risk assessment and upper-limb disorders contain valuable advice.

Breathing difficulties

Respiratory disorders are common in the food industry. The most prevalent is allergic rhinitis — hay fever-type symptoms with a clear nasal discharge, or blockage, watering eyes and sneezing caused by exposure of the lining of the nose to larger airborne particles or droplets, which trigger an allergic reaction.

Somewhat more serious is the possibility of progression to asthma, arising from the passage of smaller droplets and particles deeper into the bronchial tree. Ramazzini described asthma in bakers in 1703, and implied that it was known in Roman times, particularly when production moved from a domestic to an ‘industrial’ setting.7 Even today, occupational asthma due to flour dust is the second most common cause of compensated occupational asthma in the UK, and is responsible for 33 per cent of all compensated disease in the food industry.8

Perhaps we should not be surprised, since flour itself comprises a complex mixture of proteins, to which is added various improvers and other ingredients in the cooking process. Also, it is ubiquitous, and generously used.

New foods bring new problems. Two or three decades ago, when scampi was becoming a popular part of the British diet, an increased number of cases of asthma was noted in prawn processors.9 A visit to one of the factories showed that the workers picked up a prawn, impaled it on a hollow spike and tapped a foot pedal, which released a pulse of compressed air, stripping the meat from the shell, and into a tray. Occupational hygienists demonstrated that this generated a fine mist of prawn protein, which could be breathed in by the worker, giving rise to symptoms of rhinitis and asthma.

Respiratory symptoms were brought under control by replacing the compressed air with water. In keeping with the occupational health and safety axiom ‘Today’s solution = tomorrow’s problem’ this produced airborne droplets, which landed on the employees’ skin, giving rise to dermatitis! In turn, this was dealt with by pointing the hollow spike away from the employee, with back-up provision of gauntlets as personal protective equipment. The more perceptive reader may now be speculating on the likelihood of the task generating work-related upper-limb disorder. It did!

(As an aside, colleagues were completely baffled by an outbreak of asthma in a furniture factory, the cause of which eluded them. However, investigating the provenance of the raw materials revealed that the hessian used on the undersides and backs of settees and armchairs had previously seen service as sacks for green castor beans! Rechecking blood samples from the affected employees showed that they had become allergic to these beans. Subsequently, thorough laundering of the material removed the trigger, resulting in a great improvement.)

So far, I have focused on examples of asthma triggered by material that is specific to the particular workplace. But it is important to remember that asthma can also be triggered by non-specific stimuli, such as temperature change, or significant exertion, so workers entering refrigerated rooms may be at risk of developing symptoms.

Asthma is regarded as a reversible disease, because the narrowing of the bronchial tubes can, in theory at least, be remedied by either removing the trigger, or using bronchodilator drugs. Another, newer respiratory disease, bronchiolitis obliterans, results in scarring of the smaller airways, and the disease process is irreversible. Workers exposed to diacetyl, a component of artificial butter and other flavourings, have been noted to be more likely to suffer from this disabling condition.10

Skin issues

Skin disorders also feature prominently in the food industry, with irritant-induced dermatitis being by far the most common. One of the problems with dermatitis is that it can become infected, with the potential for transmission to the product, leading to a possible public-health hazard. More than 200 cases are reported annually by dermatologists and occupational physicians, with the triggers identified as soaps, detergents, skin sanitisers and other cleaning products.11 The food handled may contribute at least as great a burden again, with bakery ingredients (Ramazzini and those bakers again!), spices, citrus fruits and some vegetables among the culprits.

This was confirmed in a survey of skin problems occurring over a seven-year period in a British food manufacturer employing about 21,000 people on 70 sites. This enabled very precise estimations of the population at risk and ascertainment of cases. Of the 210 cases, 96 per cent were due to irritant dermatitis, of which just under two thirds were attributed to food materials, and a quarter to cleaning products. However, 9 per cent of cases were due to latex in protective gloves. The highest rates — more than double the average — were found in areas where cold and wet materials were handled.12

Another axiom, based on words attributed to Sherlock Holmes, holds that: “When you have excluded the impossible, whatever remains — however improbable — must be the cause.” I was asked to take an interest in some employees of a food-processing factory, who were complaining of sunburn — in January! I visited the premises and spoke separately and privately to the workers; indeed, their skin lesions were compatible with sunburn.

When inspecting the workplace, I noted five insectocutors suspended from the ceiling. They produce ultra-violet light, which lures insects to their death against an electrified grille, the frazzled bodies dropping into a tray at the base of the appliance, which can be emptied at the occupier’s convenience. This is far superior to the use of chemical sprays, which might pollute the product. Besides, the dying bugs may end up in the food.

“Aha,” I thought, “this is photodermatitis”. I requested the Safety Data Sheets. However, none of the chemicals could be implicated. Besides, they had been in use for several years, and the rest of the factory had identical insectocutors and chemicals, but no affected employees.

A dermatologist colleague with an interest in work-related skin problems accompanied me on a subsequent visit, together with a health physicist, to measure ultra-violet levels. The physicist set up his gauges, obtaining 10 representative readings. In seven of the 10 locations, employees were exceeding their daily dose of ultra-violet radiation and, in four, this was occurring within 20 minutes! We turned the devices off and dismantled them to find that some of the tubes were of the type used to sterilise surgical instruments. We never worked out how they came to be there, but replacement with more appropriate ones solved the problem.13

Animal instincts

Workers may be exposed to the risk of zoonoses (infectious diseases of animals potentially transmissible to humans), such as bovine TB, anthrax and Q fever. While these are very rare, spectacular outbreaks may occur — in 2006, more than 50 employees at a meat-processing plant in central Scotland developed the ‘flu-like

 Q fever.14 Eventually, 138 cases were counted, 48 of which came from four central and eastern European countries.15 While most recovered, up to 10 per cent will eventually develop heart-muscle damage.

Action stations

So far, I have not described any role for occupational-health staff. This is because the principal way in which employees will be protected from ill health arising as a result of work is by reducing, or even eliminating, exposure rather than employing doctors and nurses. That said, occupational-health staff can set up and run health surveillance programmes, where the need for them has been identified.

Most work-related health problems tend to become evident early in employment, as long as the process remains the same. For employees exposed to potential respiratory sensitisers, lung-function tests should be carried out at entry, then after six, 12, 26 and 52 weeks, then at least annually. However, the tests should not just be performed and filed away — they need to be looked at and analysed, both on an individual and group basis, and appropriate action taken.

When 24 employees in a salmon-processing plant developed respiratory symptoms, this action enabled the cause to be rapidly identified and corrective action taken. Eleven of the 24 were able to resume their duties. While 13 could not, at least their symptoms remitted, and lung function returned to normal.16

Occupational-health staff may be able to offer advice with regard to recruitment. It may be tempting to simply exclude smokers, or anyone with a history of, or current, chest or skin problems.17 However, these are very blunt discriminators because they are very common in the population, so employers may not be able to assemble a workforce! Furthermore, this also raises the possibility of being accused of discrimination under the terms of the Equality Act 2010.

One of the problems that arises for health and safety advisors in the food industry, and perhaps makes their tasks rather more difficult than their peers in other sectors, is that there is a potential for clash between health and safety legislation, designed to protect the employee and others at work, and food safety regulations, the aim of which is to safeguard the public from food-borne disease and poor quality food.

The extraction system behind the afore-mentioned outbreak of asthma at the salmon-processing plant was designed to comply with food-protection requirements. The handwashing that can cause dermatitis, and the cleaning of machinery and the work environment using water/steam and chemicals, which creates slip and scald hazards, are all examples. These conflicts need to be resolved, perhaps by employing methods advocated by Cooke.18

Summary

The examples above help demonstrate that safety advisors will best protect the interests of their employers and fellow employees by acquiring a thorough knowledge of the processes involved — from provenance of raw materials to completion of the process (together with cleaning up at the end of the shift — do they just use the mark 1 brush to raise dust clouds?) and including maintenance activity.

There are opportunities for the safety advisor to adopt a proactive approach by studying both self- and medically-certificated reports of sickness absence, or simply walking about the workplace and asking employees, particularly if there have been changes in procedures, or if employees are new to a process. Once the ‘something’s not quite right here’ feeling has taken hold, the safety advisor should informally advise the company’s managers, and start to gather information on a more methodical, standardised basis.

It is important to ensure that line managers, employees and their representatives know what is going on, why it’s happening, that they agree with it and what is going to be done with any written and video data that you collect (there may be data-protection implications).

References

 1    http://archive.defra.gov.uk/evidence/
 statistics/foodfarm/food/pocketstats/
 documents/foodpocketbook2010.pdf
 2    Ide, CW (2007): ‘Troubled waters’, in SHP September 2007 Vol.25, No.9, pp39-42 — insert web address when search is working xxxxxxxxxxxxxxxxxxxxxxx
 3    Ide, CW(2008): ‘Pastoral care’, in SHP November 2008, Vol.26, No.11, pp47-50 — insert web address when search is working xxxxxxxxxxxxxxxxxxxxxxx
 4    Malagie, M: ‘Food industries’, in ILO Encyclopaedia of Occupational Health & Safety, 3rd Edition, Vol.1, WHO Geneva, pp901-903 — www.ilo.org/oshenc/part-x/ food-industry/overview-and-health-effects/ item/857-food-industry-processes
 5    www.hse.gov.uk/food/occhealth.pdf
 6    McKeown, C (2011): Ergonomics in action — a practical guide for the workplace, IOSH Books
 7    Ramazzini B (1703): De morbus artificum diatriba (English-language translation 1705), pp142-159 Eighteenth Century Collection Online
 8    www.hse.gov.uk/food/asthma.htm
 9    Gaddie J, Legge JS, Friend JAR, Reid TM (1980): ‘Pulmonary hypersensitivity in prawn workers’, in The Lancet 1980; ii:1350-3
 10    Halldin CN, Suarthana E, Fedan KB, Lo YC, Turabelidze G, Kreiss K (2013): ‘Increased respiratory disease mortality at a microwave popcorn production facility with worker risk of bronchiolitis obliterans’ in PLoS One, Feb 28 2013
 11    www.hse.gov.uk/food/dermatitis.htm
 12    Smith, TA (2004): ‘Incidence of occupational skin conditions in a food manufacturing company: results of a health surveillance programme’, in Occup Med 2004;54;227-230
 13    Forsyth A, Ide CW, Moseley H (1991): ‘Acute sunburn due to accidental irradiation with UVC’, in Contact Dermatitis 1991,24;2:141-42.
 14    Donaghy M, Prempeh H, Macdonald N (2006): ‘Outbreak of Q fever in workers at a meat-processing plant in Scotland, July 2006’, in Euro Surveill. 2006; 11(34):pii=3031 — www.eurosurveillance. org/ViewArticle.aspx?ArticleId=3031
 15    www.cdc.gov/eid/article/13/12/07-1058_article.htm
 16    Douglas JDM, McSharry C, Blaikie L, Morrow T (1995): Occupational asthma caused by automated salmon processing’, in The Lancet 1995,346;737-40
 17    Nicholson PJ, Cullinan P, Burge PS, Boyle C (2010): Occupational asthma — Prevention, identification, management. A systematic review and recommendations, British Occupational Health Research Foundation 2010
 18    Cooke, M (2011): ‘H & S unplugged’, in SHP November 2011, Vol.29; No.11, pp46-48

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