Coshh Assessment For Work Place Health And Safety - Skin And Inhalation Exposure To Chemicals
It was presumed in the early days of health , safety and hygiene that Inhalation
exposure was the easiest route for toxic substances to gain access to the body's internal organs and systems and that the lungs gas exchange region was said to have an extremely large surface area even larger then the surface area of the skin. The skin was also said to be relatively impenetrable barrier thus preventing toxins from entering the body. The idea that one might breathe in a toxic substance raises much higher emotive concerns than the idea that some might land on the skin.So effort tended to be concentrated on preventing inhalation of toxic gases, aerosols, vapours, fumes and dust to protect the workforce and to meet the stringent requirements of the CoSHH regulations. Much research and many studies resulted in clear occupational exposure limits that employers must ensure are not exceeded in the working environment, techniques for measuring airborne exposure, etc. The need for regulatory compliance placed emphasis on inhalation exposure, such that skin exposure tended to be accorded a much lower priority.
is this reflecting modern day reality?
If one studies the statistical and epidemiological evidence that now exists, then some interesting facts come to light. In those countries where effective data collection on the causes of occupational health exist, there is clear evidence that damage to health due to skin exposure remains, if not the, then certainly one of the most significant factors.
Let's take a look at some of the evidence.
Both the number of cases and the rate of skin diseases in the U.S. exceed respiratory illnesses. In 2006, 41,400 recordable skin diseases were reported by the Bureau of Labor Statistics at a rate of 4.5 injuries for 10,000 employees, compared with 17,700 respiratory illnesses with a rate of 1.8 illnesses per 10,000 employees.
U.S. Department of Labor, Occupational Safety and Health Authority, Technical Manual, Section II, Chapter 2
In other words skin diseases exceeded respiratory disesease by at a ratio of 2.36:1!
Similarly, in a study by dermatologists in Denmark, the significance of skin disease is clear.
Compensation claims - Principal diagnosis
2853 - Skin diseases (36%)
1640 - Muscular skeletal disorders
791 - Respiratory system disorders
320 - Circulatory system disorders
278 - Poisoning
2078 - Other
7960 Total
Halkier-Sorenson C, Occupational skin diseases, a case study from Denmark, Contact Dermatitis, 1998, 39, 71-78
And from the European Agency for Safety and Health at Work, Fact Sheet no. 40:
Occupational skin diseases are estimated to cost the EU 600,000,000 euros each year, resulting in around 3 million lost working days. They affect virtually all industry and business sectors and force many workers to change jobs.
Note that these statistics relate only to the incidence and prevalence of occupational skin disease. There is almost no data on the contribution that skin contact and skin penetration plays in the development of systemic disorders. However, what evidence there is indicates that this has to be significant. with some chemicals uptake from contact with skin is most significant then the uptake associated with inhalation.
We need to keep in mind that it is the dose that reaches the target organ that is critical for the potential systemic effect, irrespective of the route of uptake. Thus when considering systemic effects we must take the sum of the three routes of uptake (inhalation, ingestion and dermal) as our exposure, rather than consider each in isolation.
the results of uptake via the skin can be just as dangerous as inhalation, as the case of Prof. Karen Wetterhahn demonstrates. A minute exposure to dimethyl mercury on her gloved hand resulted in body uptake (due to permeation through the glove) and her untimely death several months later. Furthermore, it is possible for airborne exposure of the skin, for example of the face, to result in contact dermatitis. Airborne contact dermatitis has been well documented in scientific literature and it has been shown that in someone already sensitised it is possible for a reaction to occur at below the legally defined inhalation exposure limit.
So perhaps it is time that those concerned with health and safety and the prevention of damage to health of workers due to chemical exposure started to devote more time to the issue of skin exposure and its consequences.
ineptly, the method how such exposure happens is sometimes complex as can be the effects. The reality is that this is actually far more complex than for inhalation exposure and requires a considerable knowledge of how the skin interacts with the workplace environment, how the skin reacts to contact with chemicals, the nature, extent and location on the body of the contact, and the consequences that can arise from this.
So in answer to the question in the title, all three routes of exposure are important, the relative importance being determined by the chemical and the nature of the exposure. In many cases relative importance will be irrelevant, as it is the total exposure that will determine the potential for damage to health.
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