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.
Noise-Induced Hearing loss
Noise is defined as unwanted sound, or sound which is undesirable by the recipient. Sound or noise at high levels can cause permanent hearing damage. The risk depends on the noise levels and how long people are exposed to them. Hearing difficulties in construction workers are roughly twice the national average3.
The Noise at Work Regulations require employers:
- To assess noise levels – good rule of thumb: stand 2 metres away from a colleague and try talking. If you cannot hear each other without shouting, action is required.
- At the First Action Level of 85 dB(A) to provide employees with information about the risks to hearing and provide hearing protection on request
- At the second action level of 90 dB(A) to control noise exposure by: Limiting the noise at source, as the first step, requiring hearing protection to be worn, and limiting the time people are exposed to noise.
The following lists indicate equipment and activity presenting a risk of hearing damage to workers. The lists are not exhaustive and are given for guidance only:
- Extreme Risk – very high levels of noise exposure are likely and extreme precautions would be necessary to avoid excessive exposure to the operator and bystanders alike. E.g. - chain saws, diamond drills and saws, explosives, pneumatic diggers, concrete road or block breaking, road laying.
- Very significant risk – high and still excessive levels would be expected unless great care were taken in selection of the equipment and/or in the control of their use. The main risk would be to the operator, E.g. – all forms of mobile equipment, compactors, compressed air tools, crushing mills, demolition, mechanical trenching.
- Significant Risk – relatively easy to avoid a problem but one might arise if care were not taken. E.g. – hoists, portable generators, cranes, foundation construction.
The following is a useful checklist for each activity required on site:
- Is the activity necessary, can it be avoided?
- Is it the quietest way of achieving the desired result?
- Can a quieter item of plan be found?
- Can the item of plant be retrofitted to reduce noise?
- Can anything else be done (screens, enclosures, absorbents)?
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Can workers other than the operator be removed from the area?6
Employers should always ensure that ear protectors are provided where there is a risk of hearing loss and that they are worn at all times.
Hand Arm Vibration Syndrome (Vibration White Finger)
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:
- Using hammer action equipment for more than half an hour each day.
- 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.
Asbestos
Asbestos related diseases kill more people than any other single work –related cause9. They are covered under the term pneumoconiosis, which literally means ‘dusty lungs’. There is usually a long delay between first exposure to asbestos and the onset of disease: this can vary between 15 and 60 years. There is no cure for asbestos related diseases. It is sensible to assume that any building constructed or refurbished before the 1980’s will contain asbestos based products9. There are three main types of asbestos – chrysotile (white), amosite (brown), and crocidolite (blue). Brown and blue are most dangerous.
Construction and maintenance workers can still come across asbestos: in stripping out old insulation from buildings, the removal of roofing felts, old floor tiles, textured paints and plasters containing asbestos, and in fire doors and ceiling tiles. In particular plumbers, carpenters, electricians and cabling engineers may also come across asbestos during routine repair, installation or refurbishment work10.
Preventative and protection measures – stop work and report any material or dust that you suspect contains asbestos, keep asbestos dust to as low a level as possible, e.g. by keeping the material damp, using hand tools and disposal of asbestos whilst still damp, ensure control measures (e.g. ventilation) are working correctly, use personal respiratory protection, wash hands thoroughly, never take protective clothing home to wash.
Ultra-Violet Radiation
Construction workers are mainly exposed to UV radiation by working in direct or reflected sunlight. Significant exposure can lead to skin cancer2. Fair skinned workers are at particular risk, but all exposed workers are at some risk. Some chemicals e.g. wood preservatives can increase sensitivity to the sun. The greatest risk occurs at times of the day and periods of the year when the sun is most intense e.g. 4 hours around midday in summer.
Preventative and protection measures – protect all exposed skin surfaces with UV blocking creams, do not remove clothing whilst working outdoors, keep checking for any changes in moles/ skin discolouration.
In conclusion, for the successful management of occupational health risks remember these two points:
- Employers must take action to prevent occupational ill health.
- Workers must be well informed about health risks.
If these are implemented effectively, then there is the chance to reduce the unnecessary toll of occupational ill health in the construction industry.
1 Good Health is Good Business
2 The ECI Guide to managing health in construction
3 Revitalising Health and Safety in Construction
4 Health in Construction – Lorraine Shepherd, The Safety & Health Practitioner June 1999
6 A guide to reducing the exposure of construction workers to noise - CIRIA
7 Health Risks from Hand-Arm Vibration - Advice for Employees - HSE
8 Preventing Dermatitis at work = HSE
9 Health and Safety in Construction Northern Ireland
10 Asbestos and You - HSE