Health and Safety Executive Executive

Managing skin exposure risks at work

Many materials used at work can affect the skin or can pass through the skin and cause diseases elsewhere in the body. If you are an employer, health and safety adviser, trainer or safety representative, this book provides practical advice to help you prevent these disabling diseases. It covers the protective role of the skin, ill health arising from skin exposure, recognising potential skin exposure in your workplace, and managing skin exposure to prevent disease.

Many employers don’t realise they have legal duties to assess the health risks from skin exposure to hazardous substances at work. This book can help you comply with those duties by preventing or controlling exposure to the hazards by using and maintaining suitable controls.

There is advice on assessing and managing risks, reducing contact with harmful materials, choosing the right protective equipment and skincare products, and HSG262 (Second edition) checking for early signs of skin disease. Published 2015 The document also contains a series of case studies drawn from a wide range of industries.

The guidance in this edition has been refreshed and references updated.

HSE Books

© Crown copyright 2015

First published 2009

ISBN 978 0 7176 6649 2

You may reuse this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view the licence visit www.nationalarchives.gov.uk/doc/open-government-licence, write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email psi@nationalarchives.gsi.gov.uk.

Some images and illustrations may not be owned by the Crown so cannot be reproduced without permission of the copyright owner. Enquiries should be sent to copyright@hse.gsi.gov.uk.

This guidance is issued by the Health and Safety Executive. Following the guidance is not compulsory, unless specifically stated, and you are free to take other action. But if you do follow the guidance you will normally be doing enough to comply with the law. Health and safety inspectors seek to secure compliance with the law and may refer to this guidance.

Contents

Introduction 5

What does the law require? 5

Why is the skin important? 5

What health problems can occur through skin contact? 6 Burns 6 Irritant contact dermatitis (ICD) 6 Allergic contact dermatitis (ACD 6 Other skin diseases 7 Systemic diseases following uptake through the skin 7

How do I recognise a skin hazard? 7 What are the consequences of diseases? 8

How do I assess the risks? 9 Exposure pathways 9 The risks from wet work 10

How can I manage risks to prevent ill health? 10

How should I avoid or reduce contact with harmful materials? 12 Avoid contact by elimination 12 Avoid contact by substitution 12 Avoid or reduce contact by using engineering controls 12 Avoid or reduce contact by using a ‘safe working distance’ 12 Avoid or reduce contact by using procedural controls 14

Other measures to protect the skin 15 Protect the skin by using PPE 15 Choosing and using protective gloves 15

Skincare 19 Choosing and using skincare products 19 Pre-work creams 19 Skin cleansers 21 Moisturisers 21 Choosing skincare products 22

Check for early signs of skin disease 22 Why should skin checks be carried out? 22 Who should carry out skin checks? 23 Action to take on finding a problem 23

Appendix 1 Key points 24

Appendix 2 Gloves sizes: Measuring your hand 25

Appendix 3 Memory aid for selecting protective gloves 26

Appendix 4 Symbols for gloves standards 28

Further reading 29

Further information 30

Introduction

1 This book explains what you, as an employer, can do to protect your employees from skin problems. It will also be useful to employees and their representatives. The book will help you identify what tasks and substances may cause harm in your workplace. It introduces practical steps for controlling the risks and will help you comply with the law.

2 Many materials or substances used at work can affect the skin or can pass through the skin and cause diseases elsewhere in the body. This book covers:

˜˜ what the law requires; ˜˜ why the skin is important; ˜˜ ill health arising from skin exposure; ˜˜ recognising potential skin exposure in your workplace; ˜˜ managing skin exposure to prevent disease.

What does the law require?

3 Employers must comply with the Control of Substances Hazardous to Health Regulations 2002 (COSHH) by assessing risks, providing and maintaining adequate control measures, providing information, instruction and training, and in appropriate cases, providing health surveillance. Employees should take reasonable care of their own and other people’s health; they should follow their training and co-operate with their employer on health and safety.

Why is the skin important?

4 The skin is the largest organ in the human body. Its main functions are to:

˜˜ provide a protective barrier against harmful substances; ˜˜ protect against injury; ˜˜ restrict the loss of moisture; ˜˜ reduce the harmful effects of UV radiation; ˜˜ act as a sensory organ (eg touch, temperature); ˜˜ help regulate body temperature; ˜˜ help detect and protect against infections; ˜˜ produce vitamin D.

5 The skin is made up of two main layers, the epidermis and dermis. The outer layer, the epidermis, provides the skin’s barrier function. However, it is not a perfect barrier – it limits the amount of material that can pass through it to affect other parts of the body.

6 If the moisture content of the epidermis is too high or too low, it can affect the skin’s barrier properties. If it is too dry, eg when working in a low-humidity room, the skin dehydrates, becomes rough, thickened and flaky and can crack through loss of elasticity. If it is too moist, eg due to prolonged contact with water, the skin becomes over-hydrated, impairing its barrier function.

Figure 1 A cross section of Between cell route Through cell route the outer layer of skin cells to illustrate the potential pathways through which chemical absorption can take place. Chemicals can also enter the body through the openings in skin surface (eg around hair follicles and through the ducts of the sweat glands)

What health problems can occur through skin contact?

7 Some substances can pass through the skin and cause diseases in other parts of the body. Other substances can cause ‘local effects’, which are limited to the skin itself. Dealing with local effects first, there are four main groups of substances that can cause skin problems, mostly at the site of skin contact:

˜˜ corrosive substances that can lead to burns; ˜˜ irritant substances that can lead to irritant contact dermatitis; ˜˜ sensitising substances that can lead to allergic contact dermatitis; ˜˜ substances that cause other diseases, eg urticaria, acne, skin cancer.

Burns

8 Severe skin damage (burns) can follow brief skin contact with a corrosive substance, eg wet cement, strong acids and alkalis. This may lead to the skin scarring.

Irritant contact dermatitis (ICD)

9 Irritant contact dermatitis is a skin reaction leading to inflammation at the site of contact. Dry, red and itchy skin is a common first sign. Swelling, flaking, blistering, cracking and pain may follow. Usually, the inflammation subsides once the skin has healed. However, repeated contact may lead to ‘hyper-irritability’ – the skin becomes inflamed more readily than normal.

10 ICD can develop after regular contact with mild irritants such as detergents, weak acids or alkalis and some solvents. It can also develop through ‘wet work’. Wet work can cause the skin to over-hydrate. It is a leading cause of ICD but often goes unrecognised.

Allergic contact dermatitis (ACD)

11 Allergic contact dermatitis (or skin sensitisation) is an ‘immunological response’ to a sensitising substance (allergen). The signs and symptoms are difficult to distinguish from ICD. Sensitisation can develop over time and it may be weeks, months or even years before it becomes apparent. However, once a person has developed an allergy (is ‘sensitised’), tiny amounts of the allergen will trigger ACD. By then, the only remedy is to prevent further exposure.

Other skin diseases

12 Urticaria is a skin condition that typically shows as a wheal (swelling) and flare (red mark) reaction. Skin irritants or allergens may cause it. It is different from ICD and ACD in that it quickly follows skin contact and disappears again within hours.

13 Skin cancer is one of the most common types of cancer. Signs of skin cancer may include a scaly patch of hard skin, a red lump or spot, an ulcer, a new mole, or a patch of skin that bleeds, oozes or has a crust. Exposure to certain chemicals, such as polycyclic aromatic hydrogen (PAH) compounds can cause skin cancer. Don’t forget that skin cancer is a particular problem for outdoor workers exposed to ultraviolet rays from the sun.

14 Acne is an inflammatory disease of the sebaceous glands and hair follicles in the skin. Pimples and pustules (white-centred bumps) mark it. Grease and oils can cause ‘oil acne’ in mechanics and roofers can develop acne from exposure to pitch.

Systemic diseases following uptake through the skin

15 Many substances can pass through the skin and cause diseases in other parts of the body (systemic diseases). Examples include bladder cancer (eg from aromatic amines) and scrotal cancer (eg from PAHs), diseases of the kidneys (eg from carbon tetrachloride), heart (eg from carbon disulphide), blood (eg from benzene) and nervous system (eg from organophosphates). Some health effects can appear quickly, some can take months or years to appear (eg cancers). Whether or not a substance causes systemic disease by skin uptake, the aim is to control skin exposure.

How do I recognise a skin hazard?

16 Hazardous substances include:

˜˜ substances/products used directly in work activities (eg adhesives, paints, cleaning products); ˜˜ substances generated during work activities (eg rosin fumes from soldering, metal fumes from welding, wood dust from sanding); ˜˜ naturally occurring substances (eg grain dust, flour, sunlight (UV radiation)); ˜˜ biological agents (eg bacteria).

17 The first step in recognising a skin hazard is to identify substances either used or generated in your workplace. Next, decide which might cause health effects following skin exposure. There are information sources that help with these steps:

˜˜ HSE’s ‘skin at work’ web pages (www.hse.gov.uk/skin); ˜˜ EH40/2005 Workplace exposure limits (see Further reading), which lists substances with a ‘skin notation’ (symbol Sk); ˜˜ the product label – look for the hazard and precautionary statements. See HSE’s packaging and labelling web pages for further information (www.hse.gov. uk/chemical-classification/labelling-packaging); ˜˜ trade associations, trade journals or trade websites.

Case studies: Exposure to chemicals Skin exposure can also cause systemic disease:

When a worker in France was disposing of some industrial waste, he splattered 2,4 dichlorophenol over parts of his arm and thigh (less than 10% of his body surface). He experienced a seizure within 20 minutes and died.

Two workers in a textile factory developed a transient brain disorder following skin exposure to ethylene glycol monomethyl ether, which they had been using as a cleaning agent instead of acetone, which had been temporarily unavailable due to a shortage.

What are the consequences of diseases?

18 For individual employees there is pain and suffering, with their social life affected. Some may have to give up their jobs. Employers can also face civil liability claims for damages if they have been negligent. For society, there are costs such as medical treatment and rehabilitation and costs from loss of earnings (eg benefits).

Figure 2 Cement burns to a construction worker’s knee. This serious injury could have been prevented either by avoiding the need to kneel down in wet cement or by providing a suitable pair of knee protectors

Figure 3 This hand shows irritant contact dermatitis. It is swollen, painful and infected

How do I assess the risks?

19 The ‘risk’ is the likelihood that workers’ skin will come into contact with hazardous substances that could affect their health. ‘Assessment’ means deciding who might be harmed and how:

˜˜ Do you have to use the substance and, if so, how much is used? ˜˜ How often is it used, and by how many workers? ˜˜ How is the substance handled – can you handle it in a way to avoid skin contact? ˜˜ Which parts of the skin are exposed and for how long?

20 Remember those cleaners, visitors, contractors and maintenance workers etc who may not be in the workplace all the time.

21 You can often do the assessment by simply watching the tasks. Where cases of skin exposure are less predictable or less obvious, using colour-indicating wipes or pads can help you detect skin or surface contamination (your trade association may be able to help you find a supplier). For situations that are more complex or where very toxic materials are used, you are advised to seek the help of a health and safety professional such as an occupational hygienist. They will help you to assess the risks and will advise you on the appropriate methods to manage those risks to prevent ill health.

Exposure pathways

22 An ‘exposure pathway’ is the link between a hazard source and a worker. Skin exposure can occur by several pathways:

˜˜ immersion – the skin is submerged into a liquid or powder; ˜˜ splashes – from decanting or mixing liquids and powders; ˜˜ deposition – when droplets, dusts, fumes or aerosols contact the skin, either as part of a work activity or incidental to it (eg emission from a nearby process); ˜˜ contact with contaminated surfaces. This can happen in a variety of ways: ˜˜ directly handling a contaminated workpiece;

˜˜ contact with contaminated work surfaces;

˜˜ residue on hands transferred to the eyes, nose and mouth;

˜˜ residue on hands transferred to tools, paperwork and food;

˜˜ removing contaminated PPE incorrectly.

Case study: Cement dust Tim’s four-year-old daughter got a painful rash that would not go away. He took her to several doctors, but the ointments they prescribed did not make a difference. Then he listened to a toolbox talk on preventing dermatitis at work. Tim works on a building site using cement − he realised his daughter may have been exposed to cement dust.

Tim began following the precautions mentioned in the talk. He cleaned the inside of his car and now always removes his work overalls before getting into it. He also follows the guidance on washing and caring for his skin. Within a few weeks his daughter’s problem was gone – Tim’s skin is better too.

The risks from wet work

23 There is no exact definition on when wet work is likely to be a risk. However, prolonged contact of more than about 2 hours (or more than 20-40 hand washes/ contacts a day) is likely to lead to irritant contact dermatitis. Wet work is the term used to describe prolonged or frequent contact with water (particularly in combination with soaps, cleansers and other chemicals). Wet work can cause the skin to over-hydrate. Dermatitis from wet work is common in trades such as hairdressing, metal machining, catering, cleaning and health care.

Case study: Repeated hand washing Fifty-five employees working for a meat-processing company were suffering from hand dermatitis. Repeated hand washing with a cleanser was routine (30–40 washes a day). Hands were often immersed in ‘over-hot’, softened, water dosed with chlorine dioxide. Gloves were not routinely used. No skincare regime was in place. No skin checking was carried out, so early signs of a problem were missed.

When the outbreak happened, the company sought the help of a consultant. His advice was to:

˜˜ reduce water temperature and control it at 32 °C; ˜˜ regulate chlorine dioxide dosing at a continuous, ideal level; ˜˜ reduce washing by 30% throughout a shift (this still maintained adequate food hygiene standards); ˜˜ supply and encourage the use of appropriate moisturising cream, before breaks and at the end of shifts; ˜˜ introduce skin checking by a responsible person.

How can I manage risks to prevent ill health?

24 Prevention is always better than cure. If you identify a skin contamination problem, you must develop measures to adequately control the risk. This will reduce the likelihood of health effects occurring.

25 Managing work to prevent ill health from skin exposure can be summed up in three key steps: Avoid; Protect; Check:

˜˜ Avoid or reduce contact with materials that cause skin/systemic problems. ˜˜ Protect the skin. ˜˜ Check for early signs of disease.

Case study: Engineering controls can reduce contact Sam was a spray painter working in a furniture factory. He sprayed furniture on an overhead conveyor belt while wearing a respirator. He stood between the furniture and the exhaust vent at the rear of the area when spraying the back of each piece. He occasionally wore rubber gloves, but they weren’t always available.

When a new paint was introduced, Sam developed a rash on his arms. Within a week or so this had spread to his legs and neck. Shortly after that, he began to develop breathing difficulties. The new paint was epoxy-based, this can cause allergies. Sam had developed allergic contact dermatitis and asthma; he eventually had to give up work. This could have been prevented if the right precautions had been used:

˜˜ Epoxy-based paints should only be sprayed in an enclosed booth or room with ventilation. ˜˜ Sprayers should be provided with air-fed respiratory protection. ˜˜ Sprayers should be provided with suitable personal protective equipment (PPE). ˜˜ Good washing facilities and skin creams should be provided. ˜˜ Health surveillance should be carried out.

Figure 4 This worker is spraying paint containing isocyanate. The fine spray, not normally seen with the naked eye, is shown up with the use of ‘Tyndall illumination’. Skin and inhalation exposure to isocyanates has the potential to cause skin allergies and asthma. The right controls should be used to minimise exposure

How should I avoid or reduce contact with harmful materials?

Avoid contact by elimination

26 This is most feasible at the ‘process design’ stage. For existing systems, ‘elimination’ usually