1. Health and Safety Executive Occupational Dermatitis What … ? Graeme Waller Regulatory Inspector (HID CI 1A)

2. CONTENT What … is dermatitis? causes dermatitis? are the common causes? has HSE investigated?

3. CONTENT … continued What … does it look like? does it feel like? legislation applies? does this mean for me?

4. CONTENT … continued What … in particular? about my employees? leading indicators can I use? lagging indicators can I use?

5. CONTENT … continued What … What.. When … is the hierarchy of control? is health surveillance? is it required? is it appropriate and how?

6. Any questions before we start?

7. What... is dermatitis? Dermatitis is a skin condition caused by contact with something that irritates the skin or causes an allergic reaction. It usually occurs where the irritant touches the skin, but not always. There are two types: allergic contact dermatitis; and, irritant contact dermatitis.

8. What … causes dermatitis? Allergic Contact Dermatitis (ACD) This can occur when the sufferer develops an allergy to a substance. Once someone is sensitised, it is likely to be permanent and any skin contact with that substance will cause allergic contact dermatitis. Often skin sensitisers are also irritants.

9. What … causes dermatitis? Irritant Contact Dermatitis (ICD) It can occur quickly after contact with a strong irritant, or over a longer period from repeated contact with weaker irritants. Repeated and prolonged contact with water (eg more than 20 hand washes or having wet hands for more than 2 hours per shift) can also cause irritant dermatitis.

10. What … are the common causes? ACD Some hair dyes UV cured printing inks Adhesives Some food (eg shellfish, flour) Wet cement Some plants (eg chrysanthemums) ICD Wet work Soaps, shampoos and detergents Solvents Some food (eg onions) Oils and greases Dusts Acids and alkalis

11. What … has HSE investigated? Face Eyelids Neck Trunk Abdomen Forearms Hands Thighs Shins Legs Feet Back

12. Morphine based Dichromates Codeine based Petroleum TheBaine Active Steroids Cleaning agents Butanol CET-3 Hydrocarbons Hydromorphone Naltrexone Ibuprofen Peroxide Sodium hydroxide Latex gloves (replaced with Nitrile) Nitrile Gloves (replaced with Neoprene) Zidovudine Z-valacyclovir TMA Nabumetone Dicyclohexylcarbodimide (DCCI) Pholcodine Dihydro Codeine Morphine Sulphate Carprofen Dichloropyrimidine Potassium carbonate Naloxone Acetone Methanol Hydrochloric Acid Aloes Diethyl-4-methyl-Bromobenzene Diethyl-4-methyl-phenyl-Malononitrile

13. You could see one or all of these signs Redness Scaling / flaking Blistering Weeping Swelling Cracking Crusting What … does it look like?

14. What … does it feel like? Someone who has dermatitis may experience symptoms of itching and pain. The signs and symptoms of this condition can be so bad that the sufferer is unable to carry on at work. Case studies involving people those with experience are available on the Health and Safety Executive website – see the links page in your pack.

15. Any questions so far?

16. What … legislation applies? Health and Safety at Work etc Act 1974 (HSWA); The Management of Health and Safety at Work Regulations 1999 (MHSW); The Control of Substances Hazardous to Health Regulations 2002 (as amended) (COSHH) ; and The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995.

17. What … does the mean for me? Keep your workplace safe and without risks to health; draw up a health and safety policy statement if there are five or more employees; ensure articles and hazardous substances are moved, stored and used safely; provide adequate welfare facilities;

18. give employees the information, instruction, training and supervision necessary for maintaining health and safety; appoint a competent person(s) to assist with health and safety responsibilities and consult employees or their safety representative/s about this appointment; prevent or adequately control exposure to hazardous substances that may cause damage to the health of employees and others affected by the undertaking;

19. provide free any protective clothing or equipment, where risks are not adequately controlled by other means; ensure that appropriate safety signs are provided and maintained; and, report certain injuries, diseases and dangerous occurrences to the appropriate health and safety enforcing authority.

20. What … in particular? assess the risks to employees health and safety. If there are five or more employees, record the significant findings of the assessment; identify measures for controlling the risks; make arrangements for putting those measures into effect; and ensure those measures continue to work and are correctly used.

21. What … about my employees? Take reasonable care for their own health and safety and that of others who may be affected by what they do or do not do; co-operate with their employer on health and safety; correctly use work items provided by their employer, including personal protective equipment; use all safe systems of work in accordance with training or instructions; To not interfere with or misuse anything provided for their health, safety or welfare.

22. Any questions so far?

23. What … leading indicators can I use? examples Have we identified potential sources of exposure? Have we eliminated or controlled the potential exposure? Have we assessed the risks and reduced levels to ALARP? Is Local Exhaust Ventilation plant being thoroughly examined and maintained?

24. What … lagging indicators can I use? examples Is dust building up in areas? Is there a change in attendance for particular areas or individuals? Are related incidents or concerns being reported? Are claims being submitted against the company?

25. What … is the hierarchy of control? Regulation 7 of COSHH states that an employers overriding duty is to prevent employees being exposed to substances hazardous to health. Where this is not reasonably practical, employers must achieve adequate control of exposure. To achieve adequate control the hierarchy listed in Schedule 2A of COSHH must be applied.

26. Most work situations will require several levels of the hierarchy to be used to adequately control the risks associated with skin exposure. –Design and use appropriate work processes, systems and engineering controls and use suitable work equipment and materials. –Control the exposure of the substance at source (eg enclosures, adequate exhaust ventilation systems and appropriate organisational measures). –Where adequate control cannot be achieved by other means, provide adequate protective equipment (such as suitable chemical protective gloves).

27. Any questions so far?

28. What … is health surveillance? Health surveillance is for the protection of individuals, to identify as early as possible any indications of disease or adverse changes related to exposure, so that steps can be taken to treat their condition and to advise them about the future. It may also provide early warning of lapses in control and indicate the need for a reassessment of the risk. Predictive tests are never likely to be totally reliable, and because certain known toxic agents still need to be used, dermatological health surveillance must NEVER be regarded as reducing the need for control of exposure and effective decontamination after exposure.

29. When … is it required? Health surveillance is required when: an employee is exposed to a hazardous agent; and the agent is known to be associated with an identifiable disease or an adverse effect; and there is a reasonable likelihood that the disease or the adverse effect may occur under the particular conditions of the work; and

30. a valid technique is available that is safe to use in the workplace and is capable of detecting the early signs of the disease or the adverse effect caused by a hazardous agent; and the technique used is unlikely to place employees at an increased risk or to cause unacceptable harm to the employees; and it is likely to benefit the employee.

31. When … is it appropriate and how? Substances known to cause severe dermatitis Skin inspection (SI) by a responsible person Substances known to cause skin sensitisation SI. In some cases, medical surveillance (MS) Substances known to cause de-pigmentation SI.

32. Substances known to cause oil acne SI Substance which may cause skin cancer MS Substances that can be taken up via skin Biological monitoring and biological effect monitoring

33. Manufacture, production, reclamation, storage, discharge, transport, use or polymerisation of vinyl chloride monomer. MS

34. Thank you for listening Any questions?