his report has been written for ‘Smiths Builders Ltd’ who wish to focus and improve on Occupational Health within their organisation. Work related ill health; also known as occupational ill health describes any illness an employee suffers because of the hazards they have been exposed to at work1. The European Construction Institute (ECI) recognises that there is a fundamental need to examine the extent, causes and management of the problem of occupational ill health in the construction industry and to improve the health culture.
Clients, designers, contractors, other experts and the workers themselves need to be involved. Historically, less effort has been directed towards health matters in the construction industry in favour of the more immediate, high profile (and perhaps more solvable) problem of safety. Nevertheless, ill health continues to disable and kill large numbers of construction workers. In fact, the delay in the effects becoming obvious is one of the main reasons why the subject should be taken seriously2, e. g. 36000 people in the UK suffer from ‘Vibration White Finger’ and over a million are at risk.
– HSE 1998, UK and US construction workers have the third highest rate of skin disorders – Buckhart et al 1993. Clients and contractors have a statutory and common law duty to develop health risk management systems, which should be based on full and careful appraisal of the health risks to which all their employees (including subcontracted workers) will be exposed. Some of the health and safety legislation that applies to construction is as follows: Construction rightly has a reputation for being a particularly unhealthy industry because its rate of work-related illness is one of the highest of all occupational groups.
Health problems within the industry are prevalent because of the number of high-risk work activities involved and the peripatetic nature of the workforce. The key risks are asbestos, musculoskeletal disorders, hand-arm vibration, dermatitis, respiratory sensitisers, skin cancer (from exposure to sunlight), and noise (these will be discussed later in the report). Action regarding risks should follow the normal hierarchy (elimination, substitution, and control) and risk assessments should identify circumstances in which health surveillance in required3.
The Construction (Design and Management) Regulations (CDM) underpin the HSE’s approach to both health and safety in construction. CDM is the key to improving health in the industry, through the reduction of risk by improved design, and the encouragement of better planning, which should have long term impact on improving standards of occupational health. The primary aim of managing health is preventing ill health: the axiom ‘prevention is better than cure’ must remain uppermost in the minds of those involved in health risk management4.
Musculoskeletal Disorders This includes work-related back pain usually from manual handling activities and work-related upper limb disorders i. e. injuries to shoulder, arm, elbow, wrists and hands and is the result of repetitive activities such as those involved in trades like plastering, carpentry and bricklaying. The most prevalent of these is back pain. Work related back pain is rarely caused by a single accident or injury, but by a series of repeated, cumulative injuries. Manual handling is the major source of injury to construction workers.
Every year, one-third of all construction industry accidents reported to HSE involve manual handling. Many construction workers experience symptoms of pain, aching and discomfort affecting their back, knees, neck and shoulders. These symptoms can be closely related to the type of manual handling activity; for example, work involving stooping and kneeling can lead to pain in the lower back and knees, while working with the arms raised above shoulder height can result in neck and shoulder pain. In each case long-term disability can result.
Preventative and protection measures – Identify through risk assessment, tasks/activities that could result in back pain, take steps to eliminate or minimise the need for manual handling, train supervisors and workers to recognise and report the early signs and symptoms of back pain, build in flexibility in job design, encouraging workers to take necessary rest breaks, encourage workers to adopt good manual handling techniques and to always stop and think before lifting any load, always use manual handling equipment required for the job and follow instructions that have been made to make the task safer.
This is vibration transmitted from work processes into workers hands and arms and affects many construction workers, e. g. chainsaws, drills and riveters. Vibrating tools with frequency of 2-1500 Hz are potentially damaging but the range 5-20 Hz is the most damaging. After exposure there is a latent period (when there are no signs or symptoms). It is a chronic progressive disorder affecting the vascular, sensor neural and musculoskeletal structures of the hand, the prevalence of which is likely to increase, as the vibration, intensity and exposure time increases.
The injuries can be painful and disabling, e. g. there can be painful finger blanching attacks (triggered by cold or wet conditions, loss of sense of touch and temperature, numbness and tingling, and loss of grip strength7). As the condition of VWF progresses, so does the area affected, extending to all the fingers and in severe cases even the thumb. To determine whether or not employees are at risk first check the documentation supplied by the manufacturer, this should warn of any risks from vibration. Also check how often and by who any hand-held powers tools, or hand-guided machines are being used.
In particular check if any employee is: 1. Using hammer action equipment for more than half an hour each day. 2. Using rotary or other action equipment for more than two hours each day. If so your employees are probably at risk. Preventative and protection measures – maintain good blood flow to the fingers by keeping the hands and body warm reducing the risk of injury – wear gloves, use warm sheltered areas for breaks, use tools with heated handles, avoid using vibrating tools/equipment for long periods of time, encourage employees to give up smoking as it affects blood circulation.
Work- related Dermatitis Occupational dermatitis affects virtually all industry/business sectors and is a particular problem for the construction industry. It is caused by the skin coming into contact with certain substances at work. When the skin is exposed to windy, wet and cold weather, the thin layer of lipids on the skins surface are removed leaving the skin more susceptible to penetration of irritants e. g. cement, mortar and plaster. Also at risk are employees carrying out work involving skin exposure to dusts, chemicals, site contaminants and ultra-violet radiation.
Development depends on a number of factors e. g. strength of the substance, length of skin contact and skin sensitivity. Examples of high-risk occupations are bricklayers, concrete workers, plasterers, and painters. Preventative and protection measure – ensure adequate washing facilities, wear the right sort of gloves, keep skin clean, ensure protective clothes are intact, use a moisture cream before and after work8, aim to keep the workplace free from contamination. Respiratory Sensitisers
When inhaled these can cause allergic reactions in the respiratory system which may be irreversible e. g. asthma. Once this sensitisation reaction has taken place, further exposure to even the tiniest trace of the substance causes symptoms1 i. e. asthma, rhinitis, conjunctivitis. Workers most at risk are those exposed to breathing respiratory sensitisers e. g. isocyanates, woods, some glues and resins. Examples of high-risk activities or processes are, welders, woodworkers, painters, and insulators.
Sensitisation can take months or years of breathing in the sensitisers. However, once a person in sensitised an immediate (within minutes) or delayed (4-24 hours) response can result. Preventative and protection measures – ensure dust and other sensitisers are removed from the work area, use personal respiratory protection, which should be provided, any sensitisation to substance should be reported immediately and medical attention should be sought, unless risk assessment shows the health risks to be minimal a system of health surveillance should be set up.