How to manage skin in the workplace has often been the Cinderella topic of occupational health and safety. So it is always good to see new books being published to inform and help those dealing with such complex issues. A new book from the British Occupational Hygiene Society – Controlling skin exposure to chemicals and wet-work – contains a great deal of information that will be of use to the occupational health and safety professional in preventing ill health due to chemical exposure.
The book starts with a basic section on human skin, followed by a chapter on the protective functions of human skin. These two chapters provide information about the structure of the skin and an overview of some of the functions the skin has to manage. Whilst reading these sections, I would strongly recommend that the reader also read appendix 1. This contains the scientific terminology commonly used, which can also be related to other sources of information.
While chapter 4, “Occupations, chemicals and diseases”, does not provide a complete list of all things that can result in occupational skin disease – not a practical proposition for a book of this size – it does provide two very useful tables. The first covers some occupations and the potential irritants or sensitizers that may be found in that industry. The second provides information about the substances that carry skin notations, a good place to start when considering the more acute or significant hazards that might be present in the workplace.
Chapters 5 and 6 (“Dermal exposure control and regulatory requirements” and “Dermal exposure pathways”) provide a good basis for understanding what regulatory requirements need to be adhered to and the various ways in which dermal exposure can occur.
The approach detailed in the chapter on “Dermal hazard identification methods” – chapter 7 – relies heavily on information supplied in the safety data sheet, the risk or safety phrases attached to ingredients and skin notations. As the author states early on in this chapter, there have been several studies that have found safety data sheets to often be lacking in accuracy and that many omit including hazardous substances. In addition to this, safety data sheets are written to comply with CHIP Regulations but do not contain the additional information necessary for a COSHH assessment. There are many substances that workers come into contact with at work that, whilst they do not carry a risk or safety phrase, can be, and often are, a primary factor in occupational skin disease. If our approach relies completely or almost exclusively on the safety data sheet, risk and safety phrases or skin notations then it is my opinion that we will be somewhat lacking in our assessment of the risk that is posed. After all, as the author so correctly points out, wet‑work is one of the major causes of occupational skin disease and, as far as I am aware, water does not carry a risk or safety phrase and is rarely if ever listed as a potential hazard on a safety data sheet. The danger with the approach described in this chapter of the book is that, if followed as written, significant risks of damage to health from skin exposure could be missed, leaving the worker at risk whilst the health and safety professional believes they have completed a sufficient dermal risk assessment.
The next chapter, covering the different methods for dermal exposure and surface contamination monitoring, gives good coverage of the myriad of techniques that can be adopted for this purpose. However, it does not explain when and how these techniques should be applied and how to then evaluate the data obtained.
Chapters 9, 10 and 11, covering the different aspects of managing risk, hold a wealth of information on different approaches and methods for reducing or controlling dermal exposure in the workplace. A reader would be hard placed not to find useful information in these chapters that can be applied to their workplace to make it intrinsically safer. However, it would have been helpful to have been provided with a clearer overview of a dermal exposure control strategy and indication of the hierarchy of controls that should be applied.
The chapter on personal hygiene is somewhat confusing, given the list of limitations stated for pre‑work creams followed by the advice that these sorts of products can play an important role in a skincare programme as a form of skin protection. The author fails to mention the studies that show that use of these creams can actually increase skin absorption. Thus the reader will not be in a position to make a balanced judgment as to the potential benefits of such products in his workplace. This despite the fact that the HSE has stated that these creams should not be used for primary protection. This chapter does, however, provide good advice on training aids for personal hygiene practices.
Whilst there is much useful information in this book, readers would be wise to treat the guidance with caution and to cross-reference information with other sources in order to ensure that they are not leaving workers’ health at risk.
Controlling skin exposure to chemicals and wet‑work – a practical book, by Rajadurai Sithamparanadarajah (Bob Rajan) OBE, ISBN 978 1 906674 00 7, BOHS and RMS Publishing. Available from the RMS Publishing, Suite 3, Victoria House, Lower High Street, Stourbridge, West Midlands DY8 1TA, website: www.rmspublishing.co.uk/BOHS.html non-members £95, BOHS members: free of charge. Further details: www.bohs.org/newsArticle.aspx?newsItem=82.
Review by Dr Helen Taylor, partner in EnviroDerm Services, who has a long-term interest in occupational skin management and a special interest in skin health surveillance.
From Occupational Health Review, September 2008