Medical Surveillance of Workers Exposed to Crystalline Silica

Abstract

There is uncertainty in Great Britain (GB) about what constitutes appropriate health surveillance for silica-exposed workers, despite evidence that new cases of silicosis are occurring. The latter is supported by data from UK-based, HSE funded, national surveillance systems for work-related illness. There is also evidence to suggest that the risk of silicosis is finite at current permissible exposure levels. Many of the industries in GB in which exposure to Respirable Crystalline Silica (RCS) may arise have signed up to a Social Dialogue Agreement (SDA), a pan-European initiative to improve the control of silica dust exposure. In part, this agreement is a commitment to undertake health surveillance where this is necessary because of a potential continuing risk of silicosis, even when recommended engineering and other controls are in place. The appropriate target population for this surveillance would likely include all workers who are exposed to levels of crystalline silica that place them at risk of developing silicosis or other silica-related lung diseases. Consequently, the GB regulator wishes to establish a standard for the health surveillance of silica-exposed workers, in order to assess whether dutyholders are complying with their duties under appropriate legislation. This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

Influence of Cytokines and Soluble Receptors in the Quality of Life and Functional Capacity of Workers Exposed to Silica

“…[4][5][6][7][8][9][10] The diagnosis of silicosis is made by chest radiograph abnormalities that show the typical pattern of nodules and scars, together with the clinical and occupational history of the patient. 11 As silicosis is an irreversible disease, treatments can only relieve symptoms and minimize the decline of lung function. 12 These patients have reduced lung function that interferes in their activities of daily living and their work.…”

Advances and Current Themes in Occupational Health and Environmental Public Health Surveillance

“…The National Health and Nutrition Examination Survey has provided nationallevel estimates of the biomarkers of exposure for many chemicals in the U.S. population. Corporations, government entities, and various workplaces often monitor the workplace for hazards and test workers for exposures and clinical measures of disease (45,78,79,81,96,109). Lacking a nationwide occupational health surveillance system, occupational health researchers have often turned to supplemental surveys to fill basic information gaps on worker health.…”

“…Corporate monitoring, medical surveillance, environmental monitoring, and a number of individual surveys play a significant role in providing useful information for the purposes of prevention and decision-making (3,12,56,87,96,109,138). The National Health and Nutrition Examination Survey has provided nationallevel estimates of the biomarkers of exposure for many chemicals in the U.S. population.…”

Respiratory Diseases Among Dust Exposed Workers

“…The WHO recommends routine evaluation every 2-5 years, ideally 'life-long' for workers exposed to silica dust [19]. American College of Occupational and Environmental Medicine (ACOEM) recommended evaluation at baseline and after 1 year, then 3-yearly for the first 10 years and 2-yearly thereafter when silicosis is the major concern and respirable silica levels are below 0.05 mg/m 3 [20]. Biomarkers of early disease could potentially benefit prevention efforts and clinical diagnosis.…”