Managing skin exposure at work and the potential for it to cause damage to health is often considered to be less important than other occupational health issues, such as respiratory disease or musculoskeletal problems. Chris Packham investigates whether or not this approach is correct.
Those who believe skin exposure to be unimportant should take a fresh look. The current regulations on hazardous chemicals contain among the global hazard classifications: H310 – Fatal in contact with skin. The unfortunate Professor Wetterhahn, a chemistry professor at Dartmouth College in the US found this to be true in an accident in 1997. An expert in magnetic resonance imaging, working in cancer research, she spilled just one drop of a chemical that today would have been classified as H310 onto her gloved hand. Believing that the glove was adequately protecting her, she did not immediately react but instead finished what she was doing. The consequence of this was the chemical was able to pass invisibly through her glove and was absorbed into her skin. A few months later, she was dead due to the effect of the chemical on her brain.
Of course, not all chemicals can do this. But many can cause genetic disorders, cancer and asthma as a result of skin contact. Consequences can potentially be serious and include: death; permanent disability; inability to find employment; and, of course, significant costs for the employer (for example, fines for breach of health and safety regulations, compensation awards or increased insurance premiums).
Role of the employer in managing skin exposure
Merely providing better skincare products or gloves, as some manufacturers would have you believe, is not the answer. What is needed is a fresh look at the workplace, the chemicals present there, how these are being used, the hazards that result from this use, and what actual, or potential, exposure, particularly of the skin, is present. The employer needs to conduct a proper risk assessment. Then, where there is deemed to be a risk of damage to health due to skin exposure, the employer must decide how to control this so as to comply with the requirement for “adequate control” as set down by Control of Substances Hazardous to Health.
Cost implications
Does this need to be expensive for the employer? Certainly there will be a cost for the risk assessment and probably for the implementation of the necessary control measures. However, experience has shown that in many cases, the changes have not only minimised the risk of the costs arising from damage to health, but have actually reduced operating costs and improved productivity. One manufacturer, having invested £5,000 in changes in the process, found that he was realising a saving of a similar amount annually by eliminating the need to provide gloves to employees.
An added complication is that when considering the effect of a chemical on internal organs or systems, we need to take account of all three routes of uptake, ie inhalation, ingestion and through the skin. As far as an internal organ is concerned, it is the total dose that reaches it that is the key factor, regardless of how the chemical entered the body. So, just regarding inhalation in isolation could result in the employer putting its workers’ health at serious risk.
So if we consider the various effects that skin exposure can have, it should be clear that merely concentrating on one particular route could result in an underestimate of the real risk of damage to health that a particular workplace situation represents.
This adds to the complexity of our risk assessment and exposure management tasks, particularly since each route can affect the others. For example, damaged skin due to contact with irritants, even when still at a sub-clinical (or invisible) level, can increase the ability of a chemical to penetrate the skin and contribute to systemic effects. Airborne exposure is not only a risk for inhalation exposure; indeed, it is possible to be below the regulatory exposure limit and still have sufficient facial exposure to represent a risk of both allergic skin reactions and systemic effects. According to Drexler (2003): “Air threshold limits are insufficient to prevent adverse health effects in the case of contact with substances with a high dermal absorption potential.”
Just to add to the problems in carrying out a risk assessment for skin exposure, while we can measure airborne levels of a chemical, we do not have any valid techniques suitable for normal workplace skin exposure measurement. The European Agency for Safety and Health at Work states: “There is no scientific method of measuring the results of the body’s exposure to risk through dermal contact. Consequently no dermal exposure standards have been set.”
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In considering health issues arising from the presence of chemicals in a workplace, we also need to include the fact that factors such as diet can also play a contributory role. What this adds up to is that:
- risk assessment for a chemical in a workplace is more complex and uncertain than many assume;
- the tools available to us to measure and quantify exposures and their significance are limited;
- how we correlate the ultimate effect of different routes of exposure is uncertain; and
- simplistic approaches may under or overestimate the real risk of damage to health.
Perhaps it is now time to reappraise what has traditionally been our approach to risk assessment and exposure management for chemicals in the working environment to ensure that what we do really does reflect current knowledge? It is also important to have effective health surveillance so that any deficiencies are detected and rectified before we are faced with a serious health issue.
