Bad vibrations

A look at the needs of workers who operate handheld vibration tools that may
increase the risk of developing hand-arm vibration syndrome (HAVS), by Jenny
Mason

Hand-arm vibration syndrome (HAVS) is a chronic disorder recognised as an
occupational disease, which occurs following sustained exposure to vibratory
power tools.

It is often described as resembling Raynauds disease; however, only the
vascular component of the condition can be confused in the two conditions.

Vibration white finger (VWF) has been prescribed under the Industrial
Diseases (Prescribed Diseases) Regulations since 1985, as reported by the Royal
College of Physicians in 1993.1

In 1997, the British High Courts confirmed that vibrating handheld power
tools can cause VWF.

The success of this test case, initiated by a group of coal miners, led the
Government to formally recognise liability in January 2000 and confirm that VWF
was an industrial disease. An agreement to pay compensation to more than 30,000
former miners suffering from the disease resulted in payouts of approximately
£500m.2

The precise number of construction workers exposed to hazardous levels of
vibration in their work remains unclear. However, based on the success of the
miners test case, construction industry employers must be aware of the
potentially high litigation costs that could be imposed if attempts are not
made to reduce these risk factors for their employees.

Ramazzini stated as far back as 1713 that: "Certain violent and
irregular motions and unnatural postures of the body, by reason of which the
natural structure of the vital machine is so impaired that serious diseases
gradually develop there from".3

While handheld power tools could hardly have been considered a threat in
1713, Ramazzini certainly recognised that repeated physical activities could be
responsible for causing ill health among workers of the day. The adverse
effects of exposure to hand-arm vibration have been recognised since 1911 when
Loriga reported "dead fingers" among Italian miners who used
pneumatic drills.4

HAVS is still prevalent today, and the Health and Safety Executive (HSE) has
recommended health surveillance for all workers in jobs identified as giving
rise to significant risk of hand-arm vibration syndrome.5

At present, there is no legislation limiting vibration exposure, but the HSE
has issued guidance to employers in the form of HS(G)88 ‘Vibration’.6

As an occupational disease, it is vitally important that occupational health
advisers (OHA) are able to recognise the signs and symptoms of the condition.
HAVS is a complex condition that can affect the vascular, nervous and
muscular-skeletal systems of the upper limbs – the hands in particular.

Vascular damage to one or more of the fingers is characterised by the
episodic blanching of the fingers.

The tips are usually the first to demonstrate signs of damage, although the
thumbs are not usually affected. Neurological symptoms may include tingling in
the fingers, loss of dexterity and reduced sensitivity to touch and
temperature, and these symptoms occur as a result of damage to the small nerve
endings in the skin.

Musculoskeletal symptoms can include muscle fatigue and a reduction in
strength, although the exact mechanism in the development of these conditions
is still not fully understood.7

Workers employed in cold working areas may experience blanching of the
fingers if affected by vibration. As vaso-dilation occurs and the circulation
to the fingers is restored, the area flushes dark red, accompanied by pain.

In advanced cases, the peripheral circulation becomes sluggish, giving a
bluish-purple tinge to the skin of the digits, and in very rare, severe cases,
trophic skin changes (gangrene) occur in the finger tips.4

The diagnosis and assessment of HAVS requires a detailed medical and
occupational history, including vibration exposure, physical examination and
special tests to assess the damage to the vascular and sensorineural systems.8

The use of the Stockholm classification in the UK has been recommended by
the HSE and by the Working Party of the Faculty of Occupational Medicine (see
box, right).9

An examination, detailed employment history and assessment of recreational
vibration exposure, will enable the OHA to provide advice and recommendations
to both the employee and employer.

To precisely identify those at risk of developing HAVS, the OHA needs to
facilitate a full and detailed risk assessment of employees.

A risk assessment of the workplace and of the tools to be used, plus a
thorough health assessment is necessary. This will allow suitable control
measures to be implemented within the organisation. The occupational history
should serve two functions – to enable the doctor to detect adverse influences
of the patient’s work on their health, and to allow sensible advice to be given
on the effects of the patient’s health on future working ability.10

Staff can be educated at pre-employment induction programmes and/or health
assessments, and the information can be reinforced at regular ‘toolbox talks’
given by the OHA or the health and safety officer.

These talks enable staff to become fully aware of the need to comply with
the recommendations set, ensuring that the recommended exposure limits to
vibration are not exceeded, and that the correct and appropriate personal
protective equipment (PPE) is provided and worn.

Because HAVS is a relatively recently recognised occupational disease, many
workers may have been developing the condition undetected.

By inviting employees to undertake health surveillance programmes, the OHA
may recognise the early development of the disease, or those that already have
an established condition, and can refer them to an occupational health
physician.

Pre-employment health assessments are an ideal opportunity to assess
employees for potential HAVS.

Historically, the construction industry has been reluctant to provide time
or facilities for staff to attend health surveillance programmes. In 1998, the
HSE published its Good Health is Good Sense document in an attempt to encourage
employers to view health in the workplace in a more positive light.

Injuries and work-related ill health costs the construction industry more
than £3bn a year, equating to £1,500 per employee every year.11

The HSE hopes that management will be encouraged to maintain a healthy
workforce, proving that good health makes good commercial sense.

Although no specific legal duties or measures must currently be taken to
reduce the risk of HAVS (HSE 1994), there is a need for employers to consider
what action is required to reduce the potential risk to staff.

Derived from the Health and Safety at Work Act 1974, the Management and
Health and Safety at Work Regulations 1999 (Regulation 3, 1, 1a), clearly state
that every employer should make a suitable and sufficient assessment of the
risks to the health and safety of its staff to which they are exposed while at
work. VWF is reportable under the Reporting of Injuries, Diseases and Dangerous
Occurrences Regulations (RIDDOR) 1995.

The primary cause of HAVS is work that involves holding vibrating tools or
work pieces. Vibration with a frequency range from 2-1500Hertz (cycles per
second or Hz) is potentially damaging , and is most hazardous in the range
between 5-20Hz (HSE 1990).

Several factors that will affect the severity of the risk need to be taken
into account. The magnitude and the length of time exposed to vibration must be
calculated to recommend a safe exposure limit. Considerations need to be made
regarding the grip of the tools and the force required to operate them. How
much of the hand is exposed to the tool will determine how much vibration is
absorbed.

Climatic factors are also important; HAVS is generally exacerbated in cold
weather and conditions. Certain lifestyle factors, such as smoking, can be
addressed at health assessments, as this can also affect the individual’s
circulatory system.

Although this article has been focused on HAVS among construction workers,
the OHA must be aware that other industries may also be exposing staff to
developing the condition. These would include staff in agriculture and
forestry, and often those in engineering or heavy industry.

It is highly possible that the construction industry could find itself
dealing with thousands of claims for hand arm vibration syndrome. Even
considering the current climate of knowledge, the benefits of health
surveillance and changes in working practice, the industry could find that this
problem may continue for many years to come.

HAVS could develop into a ‘legal minefield’ for employers, therefore it is
vitally important that those providing occupational health become vigilant on
health surveillance techniques, provide accurate records and ensure that any
recommendations made are understood and ideally, implemented.

Information relating to HAVS is constantly being published in journals –
both medical/occupational health and industry. The OHA needs to be constantly
aware of any research-based evidence on the subject, changing practices and
recent legal cases. For example, the European Council has now adopted a
directive on physical agents that cause vibration, (2002/44/EC, see Resources,
page 31).

The days when the only medical care provided on construction sites was
someone in a first aid hut putting plasters on cuts, are long gone.

Certainly, some of the larger construction companies have been leading the
way for some time in promoting an effective, pro-active service that will help
improve the health of staff while at work, but there is still a long way to go.

Jenny Mason RGN, BSc (Hons), Dip (OH)

References

1. Royal College of Physicians, Hand Transmitted Vibration: Clinical Effects
and Pathophysiology, Part 1: Report of a working Party, The Royal College of Physicians
of London, 1993

2. Law S, Managing Hand-Arm Vibration Syndrome, Health and Safety Briefing,
No 188, pages 4&5, 2000

3. Ramazzini, Bernardino, Diseases of workers, 1713, The classics of
medicine library, University of Chicago press, Illinois, published 1940,
Special edition 1983

4. Pelmear P, The HAVS, Management OHS & E, July 1999, pages 27-30

5. Lawson I, Nevell D, Review of objective tests for the hand-arm vibration
syndrome, Occupational Medicine, vol 47, No 1, pages

15-20, 1997

6. Health and Safety Executive, Hand-Arm Vibration HS(G) 88, HSE Books HMSO,
1994

7. Shelmerdine L, Managing Hand-Arm Vibration Syndrome – A Guide for Nurses,
Nursing Standard, Vol 13, 22, pages 45-47, 1999

8. McGeogh K, Welsh C, Results of independent medical interview and
examination in the diagnosis and assessment of hand-arm vibration syndrome,
Centre European Journal Public Health Supplement, pages 107&108, 1995

9. Health & Safety Executive, A brief history of Hand-arm vibration,
Stockholm scale revised the Taylor-Pelmear scale for assessing both vascular
and sensorineural components of VWF, 1987

10. Seaton A, Aguis R, McCloy E and D’Auria D, Practical Occupational
Medicine, 3rd Edition, Arnold, London, 1994

11. Green B, Nursing a Healthy Concern (1995), Contract Journal, 2002, pages
18&19

www.hse.gov.uk

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