To those of you working within healthcare - is regular lung function/spirometry testing carried out on staff working in histopathology laboratories as part of regular health surveillance? I'm aware that it would be valid for those having significant exposure to chemicals and solvents which are known respiratory sensitisers but should it be used for those working in contact with formaldehyde vapours?

Also, is there any news on proposals to reduce the WEL for formaldehyde?

If you consult the sixth edition of the ACoP for COSHH you will find that the conditions where health surveillance is required have changed.

Examples where health surveillance is appropriate under the criteria in regulation 11(2)(b) are:
where there have been previous cases of work-related ill health in the workforce/place;
where there is reliance on PPE, eg gloves or respirators, as an exposure control measure; eg printers wearing gloves to protect against solvents used during press cleaning, or paint sprayers using two-pack paints wearing respirators to prevent asthma. Even with the closest supervision there is no guarantee that PPE will be effective at all times;
where there is evidence of ill health in jobs within the industry; eg frequent or prolonged contact with water (termed ‘wet-working’) causing dermatitis in hairdressers and healthcare workers, or breathing in mists from chrome plating baths causing chrome ulcers in platers.

Paragraph 238 amplifies this:
This is not a definitive or exhaustive list and there will be many other instances where health surveillance is required. Employers will need to seek information or advice on the specific health risks identified in the risk assessment, or through any topic-specific HSE guidance, trade associations or other professional sources.

Not only does this say to me that you should consider lung function testing but also that, in the light of the chemicals you mention, you should consider skin health surveillance.

Chris

It isn’t quite as simple as just lung function testing.

“Air threshold limits are insufficient to prevent adverse health effects in the case of contact with substances with a high dermal absorption potential.” - Drexler H, Skin protection and percutaneous absorption of chemical hazards, Int. Arch Occup. Environ. Health (2003) 76:359-361

What this is saying is that you can be below the WEL (which is only relevant for inhalation exposure) and still have sufficient airborne exposure to cause skin uptake and a subsequent allergic reaction.

“Under ‘industrial conditions’ skin absorption could account for up to 42% of the total body burden for 2-butoxyethanol” - Factors affecting the extent of dermal absorption of solvent vapours: A human volunteer study - Jones K, Cocker J, Dodd LJ, Fraser I, Ann.Occup.Hyg. 47, 2, 2003 (Note that this was to airborne exposure, not direct skin contact with the liquid form.)

I have even had a medical diagnosis of occupational allergic contact dermatitis to formaldehyde that turned out to be a facial dermatitis due to that person’s diet.

With xylene uptake can occur and damage accumulate at a sub-clinical (invisible) level due to the cumulative effect of repeated exposures not just to xylene but to other irritants, including water and the damaging effect of wearing gloves. Eventually, possibly after months or years (which will vary according to the individual’s personal skin characteristics) the skin’s resistance may break down and the contact dermatitis appear. How certain are you that this is not happening? It is possible to detect the cumulative effect of sub-clinical irritant damage by measuring residual skin hydration levels.

Chris

Toe

There is a lot of evidence now that skin exposure to isocyanates can result in sensitisation leading to asthma. So just concentrating on preventing inhalation might not be sufficient to protect the workforce. From my contacts with the HSE and their views on the use of isocyanates in a workplace this should trigger at least a baseline check to establish whether there is an issue. Remember that for systemic damage it is the total dose reaching the target organ that is the important factor, irrespective of the route(s) of uptake (inhalation, ingestion, skin).
Chris