Under the skin

Occupational skin disease may be even more prevalent than previously
believed, according to new research from the HSE, and many employers are
failing to take adequate measures to protect their staff, by Eliza O’Driscoll

About four million working days are lost in the UK each year because of skin
disease, with an annual cost to industry of hundreds of millions of pounds,
according to the Health and Safety Executive.1 And a recent piece of research
commissioned by the HSE on occupational dermatitis in the printing industry
showed that nearly half of all printers had suffered from dermatitis at one
stage or other.2

The main aims of the study were to investigate the prevalence of dermatitis
in a sample of people working in the printing industry and to assess how much
current dermatitis might be occupationally related. The findings are very much
higher than current UK surveillance schemes which monitor occupational health
disease. A total of 58 per cent of the skin problems diagnosed were thought to
be occupationally related, and three-quarters of those reporting a problem said
that it cleared up when they were away from work.

The findings of the report have serious implications for other industry
sectors which are known to be at a greater- than-average risk of occupational
skin disease. Industries and occupational groups identified by the HSE as being
at particular risk of work-related skin diseases are: catering and food
processing, engineering, agriculture, hairdressing, cleaning, printing, health
care, construction, rubber manufacturing/processing and offshore industries.3

The duties of employers to safeguard the health of employees are clearly set
out in the Control of Substances Hazardous to Health Regulations 1988 .

COSHH Regulations

Regulation 7(1) states:
Every employer shall ensure that the exposure of his employees to
substances hazardous to health is either prevented or, where this is not
practicable, adequately controlled.

Regulation 7(2) states:
So far as is reasonably practicable, the prevention or adequate control of
exposure of employees to a substance hazardous to health shall be prevented by
means other than the provision of personal protective equipment.

So the employer is required to ensure that the exposure of employees to
hazardous substances is either prevented or adequately controlled.

If it is reasonably practicable, exposure must be prevented by changing the
process or activity so that the hazardous substance is not required or generated;
or replacing it with a safer alternative; or using it in a safer form – for
example, pellets instead of powder. If prevention is not reasonably
practicable, exposure should be adequately controlled by one or more of the
measures (such as total enclosure of the process) outlined in the Regulations.

But as Chris Packham, occupational skincare expert and managing director of
skincare consultancy Enviroderm Services, points out: "reasonably
practicable" only applies to prevention not to "adequate control".
Thus legally if the employer cannot adequately control exposure then legally he
cannot carry out that operation. However, the meaning of "adequately
controlled" is legally unclear. Occupational exposure standards do not
apply to skin exposure, only to respiratory exposure.

Personal protective equipment

However, in many industries, even after taking all the steps to remove or
control the hazard that are reasonably practicable, further precautions to
prevent occupational skin disease are still going to be necessary. In this case
training and instruction for both employees and managers, and health
surveillance, in the form of visual inspections, are the next line of defence.
And this is also the point where personal protective equipment comes into play.

"Risk management requires that we control the exposure by methods other
than the use of personal protective equipment," says Packham.

"Gloves must be a last resort. This is for a number of reasons, not
least because we then rely upon the worker and thus have less control and
because gloves are always in danger of being damaged."

The findings of the HSE’s report into the printing industry bears this out.
"The research has demonstrated that all too often there is a mistaken
belief that sufficient protection will be achieved by using gloves alone.
However, gloves need to be carefully selected to give protection against the
product in use, they need to be maintained and replaced when damaged, and
people using them need to be aware of good hygiene practice to avoid
contamination within the glove," says Andrew Porter, chairman of the
Printing Industry Advisory Committee.

Barrier creams

And if gloves are not the answer, barrier creams are even less likely to
have a protective effect. In fact a recent HSE publication declares,
"Pre-work creams cannot be relied upon for primary protection of the skin
as there is no information on the rate of penetration of chemicals through

"Also, people habitually miss areas of their exposed skin when applying
creams and so complete skin cover cannot be guaranteed. It is not always
obvious if the barrier has been removed, damaged or thinned. Because of this,
pre-work creams should not be regarded as personal protective equipment. They
cannot give the same level of protection as gloves and should not be used as an
alternative to properly selected protective equipment." 3

In his most recent skincare bulletin Enviroderm’s Chris Packham reinforces
this point.4

"The performance of personal protective equipment such as gloves can be
quantified by tests carried out by the manufacturer. The manufacturer will then
publish these data, usually showing the performance of each product against a
range of chemicals. I have yet to find a manufacturer of the creams able to
produce similar data for the performance of their product as protection. All
too often vague claims are made, hedged with ‘let-out’ clauses, such as ‘helps
protect’, the meaning of which is impossible to determine.

"What is required is a series of double blind studies under strictly
controlled conditions of actual work to demonstrate whether or not a cream is
effective. As far as I am aware no such experiment has ever been carried out
under actual working conditions," says Packham.


1 Health and Safety Executive (1996) Skin creams and skin protection in the
engineering sector, EIS14 C25.

2 Livesley E, Rushton L (2000) The prevalence of occupational dermatitis
amongst printers in the Midlands. (Contract research report 307/2000) ISBN

3 Health and Safety Executive (2001) Assessing and managing risks at work
from skin exposure to chemical agents, ISBN 0-7176-1826-9.

4 Enviroderm Services. Barrier creams, Technical Bulletin No 10, www.enviroderm.co.uk.

HSE advice on pre-work creams

Pre-work creams are not liquid gloves. There is no such thing. They will not
give the same level of protection as properly selected gloves. Never use a
cream if a glove will do the job because:

– When washing their hands most people regularly miss certain areas. Equally
the same tends to be true when applying a cream. Areas of the skin may be left
unprotected – the equivalent of wearing gloves with holes.

– When selecting gloves it is necessary to take into account how quickly the
hazardous substance will penetrate the glove material. Data is available for
goves but is not yet available for creams.

– Personal protective equipment is subject to wear and tear. With gloves
this can easily be checked.

– Creams begin to wear off as soon as work commences, but the loss of
protection is unlikely to be so apparent.

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