NEBOSH

Diploma Part 1

Unit 1E1 Occupational Health Risks

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 History
• 2nd Century - use of bladders by miners
• 16th Century - Agricola wrote books on
mining diseases
• 1700 - Ramazzinin published book on
occupational diseases
• 19th Century - Charles Thackrah
established concept of occupational
medicine
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• 1833 - Factories Act required doctors to certify that
children were over 9 years of age in textile
industry

• 1855 - Certifying Surgeons required to investigate

industrial accidents

• 1895 - Poisoning by lead, phosphorus & arsenic and

exposure to Anthrax notifiable

• 1898 - Thomas Legge appointed as first Medical

Inspector of Factories

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• 1948 - Certifying Surgeons became Appointed Factory
Doctors

• 1972 - EMAS set up

• 1978 - Royal College of Physicians set up Faculty of

Occupational Medicine

• Royal College of Nursing recently set up a Society of

Occupational Health Nursing

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 Occupational Health

• Pathology - study of diseases

• Anatomy - study of body structure
• Physiology - study of body
functions
• Toxicology - study of the effect of
harmful substances on the body

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The various anatomical systems can
be studied independently but they do
not function in isolation e.g. the
respiratory and digestive systems are
dependant on each other

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Routes of Entry

• Absorption
• Ingestion
• Injection
• Inhalation

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 Respiratory System
• Windpipe
• Two Bronchi
• Bronchioles
• Alveoli/air sacs
• Lung membranes are the pleura
• Air sacs transfer oxygen to the
blood and receive carbon dioxide
from the blood
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Abdominal Digestive Organs
• Mouth
• Esophagus
• Stomach
• Small/Large intestines
Food is broken down by chemical
action and the products of digestion
pass through the gut wall into the
blood stream and then to the liver
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 The Liver
• A key organ which changes sugar
into glycogen and breaks down
proteins to form urea as a waste
product
• Takes old blood cells and stores the
iron
• Manufactures bile
• Detoxifies poisons
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 The Circulatory System
• Heart
• Arteries
• Veins
• Capillaries
The blood carries oxygen to body
tissues, removes waste products e.g.
carbon dioxide, dissipates heat and the
white blood cells form part of the
immune system
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 Nervous System
• Brain
• Spinal cord
• Nerve network
• Can be paralysed by a wide range of
natural and man-made substances

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 The Skin
• Epidermis
• Hairs
• Dermis
• Sweat glands
• Sebaceous glands
• Pores

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Performs a variety of functions:
• Physical protection against chemicals,
germs etc.

• Control of body temperature via sweating

• Loss of water and salts

• Sebum is a waxy material which protects

the skin but can be removed by solvents
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 The Eye
• Approx. 25mm in diameter
• Cornea
• Lens
• Retina
• Light falling on retina cells results
in signals being sent to the visual
cortex

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 The Ear
• Auditory canal
• Eardrum
• Ossicles - amplification
• Cochlea - hair cells
• Signals sent via auditory nerve to
brain
• Excessive noise can cause
permanent damage

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Types of health hazard

• Physical
• Chemical
• Biological
• Ergonomic
• Psychological

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Physical Hazards

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 Noise
• Amplitude - energy
• Frequency - pitch
• Human range 20 to 16,000 Hz
• Hearing impairment - loss of higher
frequencies
• Loudness - response at lower
frequencies requires larger
amplitude

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 Measurement of Sound
• Pascals - 20mPa to 200 Pa (1 to 106)
audible range
• Decibel- 0 to 150 dB
• Increase of 3dB doubles the sound
level
• A weighted curve dB(A) - takes into
account different sensitivity of
human ear at different frequencies

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Typical Sound Levels
140: Threshold of pain
120-110: Pneumatic drill
100: Loud car horn
90: Inside tube train of bus
70: Conversation
60: Office
40: Library
15-20: Bird song
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Sources of Workplace Noise
• Machinery
• Air pumps
• Alarm systems
• Vehicles
• Pneumatic/hydraulic systems
• Hammer drills
• People

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Effects of exposure to noise
• Threshold shift - a protection
reflex which damps nerve impulses
and makes the ear less sensitive to
low noise levels

• Can be either temporary or

permanent

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Noise induced hearing loss
(NIHL)
Caused by the hair cells in the inner
ear being permanently damaged and
failing to respond to the movement of
the cochlea

Damaged hair cells do not regrow

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 Acute Effects
• Acute acoustic trauma - e.g. from
gunfire. Affects the eardrum and
the ossicles
• Temporary threshold shift -
affects the cochlea
• Tinnitus - ringing in the ears
caused by intense stimulation of the
auditory nerves
• Acute effects are usually reversible
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 Chronic Effects
• Permanent threshold shift
• NIHL - affects the ability to hear
human speech. Compensation
possible to a certain extent
• Tinnitus - can become chronic
without warning. Mainly irreversible.
• Presbycusis - ageing in the ossicles
in older people

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 Vibration
• Causes problems to the body,
machines and structures
• Low frequency (3-5Hz) can cause
diaphragm to vibrate - nausea
• Frequency range 20-30Hz affects
head, neck & shoulders
• Frequency range 60-90Hz causes
eyeball resonation
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• Higher frequency vibrations can cause
• Vibration White Finger (VWF) due to
the blood vessels contracting

• VWF can become permanent

• Effects of vibration depend on the

amplitude, frequency & period of
exposure

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Protection from Vibration

• Remove source of vibration

• Choice of tools
• Reduce exposure time
• Anti-vibration mounts
• Isolated seating

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 Heat
Can cause heat or cold stress and
assessments must take into account:

• The work rate

• Type of clothing worn/required
• Amount of heat produced or lost by
the body

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 High Temperature

• Dehydration
• Physical heat exhaustion
• Radiant heat burns
• Heat stress

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Minimising effects of heat
• Acclimatisation
• Regular fluid intake
• Work breaks
• Adequate ventilation
• Humidity control
• Suitable clothing
• Screening against radiant heat
• Health surveillance

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Typical work situations
• Foundries
• Confined spaces
• Kitchens
• Forges
• Refineries
• Open air in Summer

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Low temperature working

• Frost bite
• Cold stress
• Restricted blood flow
• Reduced mobility
• Sickle Cell Disease

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Minimising effects of cold

• Work breaks
• Suitable clothing
• Hot drinks

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Typical work situations

• Cold stores
• Confined spaces
• Wet conditions
• Outside in Winter
• Bridge work
• Steeple jacks

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Radiation

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Non-ionising radiation
• Infra red
• Visible light
• Laser light
• Ultra violet
• Radio frequency
• Electro-magnetic

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 Infra red
• Emitted when matter is heated
• Heats skin and cornea
• Long term exposure can cause
cataracts
• Eye protection essential

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 Visible light
• Sources include the sun, arc
welding and arc lamps

• Main effects are burning to the skin

and eye damage

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 Laser Light
• Lasers intensify light in IR, visible
and UV regions
• Can deliver large amounts of power
over large distances
• Range from low powered lasers in
domestic equipment to steel cutting
lasers
• Classified 1 to 5
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 Protection from laser light
• Equipment design
• Enclosure of the device
• Interlocks/shutters
• Warning signs
• PPE
• Operator training
• Elimination of reflective surfaces
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 Ultra violet
• Sources include the sun, arc
welding, plasma torches
• Affects the skin causing sunburn,
arc eye and snow blindness
• Long term causes skin ageing,
cataracts, skin cancer
• UV reacts with oxygen to produce
ozone
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Protection against UV light
• Enclose the source
• Fitting of interlocks on enclosures
• View only through special filters
• Use goggles or face shields
• Outdoors use filter creams,
sunglasses etc.

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 Radio frequency
• Microwave transmitters e.g. ovens,
radar, radio masts
• Causes heating of the body
• Mobile phones increase blood flow in
the brain - cooling attempt
• Shield metals, tools, flammable &
explosive materials from microwaves

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 Electromagnetic radiation
• Low level EMR comes from
display screen, power cables etc.
• No firm evidence of harm to people
• No evidence of harm during
pregnancy
• Guidelines issued by National
Radiological Protection Board
(NRPB)

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 Ionising Radiation
Matter is made up from:
• Protons - unit mass, positive charge
• Neutrons - unit mass, no charge
• Electrons - mass 2000 times less than
proton, negative charge
• Nucleus of atoms consist of protons
and neutrons
• Nucleus surrounded by electron cloud
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 Elements
• Elements e.g. carbon, oxygen
different due to number of protons
• 90 occurring naturally + some man
made e.g. Americium
• If number of electrons does not
equal number of protons the atom
will be charged (+ or -) and is said
to be ionised
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 Isotopes
• Same number of protons but
different number of neutrons
• Some can spontaneously change
into other elements or isotopes
emitting radiation
• Known as radioactive elements
• Radiation can be emitted in several
forms

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 Alpha Particles
• Heavy particles with two protons
and two neutrons (Helium nuclei)
• Double positive charge
• Very short range
• Outside the body they do not
present a significant hazard
• Inside the body intense local
ionisation can occur
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 Beta Particles
• Mass and charge equal to electrons
• Degree of penetration depends on beam energy
• Penetration up to 2.5 cm in soft tissue possible
• Do not cause as intense ionisation as alpha
particles
• Produce Bremsstrahlung radiation in air with
greater penetration than beta particles alone

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 Gamma Rays & X-rays
• Electromagnetic radiation
• Gamma rays produced by radioactive
decay and gamma sources produce
radiation continuously
• X-rays produced by bombarding metals
with beta particles in a vacuum
• Radiation ceases when equipment is
switched off
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 Neutrons
• Produced during nuclear processes
• Uncharged and greater penetrating
power than alpha particles
• Can cause ionisation by collision
with nuclei

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 Degree of Penetration
Radiation follows an inverse square law:

I=Cx1
D2

where I = Intensity, D = Distance from source

and C = a constant

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 Effects on the body
• Ionising radiation causes the body
tissues to become ionised resulting
in ion pairs, free radicals and
oxidation products
• These disrupt normal cell function
• The gross effects can be burns and
cancer

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 Cancerous effects
• Tumours in various organs

• Teratogenic: embryos

• Mutagenic: future generations

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 The Ionising Radiation
Regulations 1999
• 1,2,3 & 4: Interpretation & general
• 4: Co-operation between employers
• 5: Notification to HSE
• 6: Restriction of exposure
• 7: Limits on doses of radiation in
any calendar year from 1st January
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 Regulation 5
Authorisation of specified practices
• A radiation employer must not use x-ray
equipment for industrial radiography,
product processing, research or exposure of
persons for medical reasons without the
prior written permission of the Executive
• Excludes electron microscopes

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 Regulation 6
Notification of specified work:

• Details how the Executive should be

informed of specified work

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 Regulation 7
Prior risk assessment
• Before commencing a new activity
involving work with ionising radiation,
the employer shall carry out a suitable and
sufficient risk assessment in order to
identify the measures needed to restrict
exposure to ionising radiations

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 Regulation 8
Restriction of exposure
• Requires a radiation employer to take all
necessary steps to restrict, so far as is
reasonably practicable,the extent to which
employees are exposed to ionising radiation
• This should be done using the following
hierarchy

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 Hierarchy of control measures
1. Engineering controls, design features &
use of safety and warning devices

2. Suitable systems of work

3. PPE

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 Restriction of dose
• Pregnant women not to receive more than 1 mSv
during remainder of pregnancy following
notification in writing to employer
• Exposure of nursing mothers to be restricted so as
to prevent significant body contamination
• Employer to investigate if exposure for other
employees exceeds 15 mSv in any calendar year

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 Regulation 9
Personal Protective Equipment

• Must comply with any provision of PPE

Regulations 1992
• Suitable accommodation to be provided
when not in use

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 Regulation 10
Maintenance & examination of engineering
controls etc. and PPE
• Must be properly maintained and where
appropriate thorough tests and examinations
must be carried out at suitable intervals

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 Regulation 11
Dose limitation
• For employees 18+ no more than 20mSv
per calendar year.
• For special cases no more than 100 mSv
over 5 years with < 50 mSv per year
• For employees < 18 no more than 6mSv per
calendar year

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 Regulation 12
Contingency plans
• Where an assessment under regulation 7
shows that a radiation accident is
reasonably foreseeable, a contingency plan
must be prepared
• If necessary rehearsals should be carried out

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 Regulation 13
Radiation protection advisor
• Must be appointed to advise the employer
• Appointment must be in writing giving
scope of advice
• Employer to provide RPA with adequate
information and facilities

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 Regulation 14
Information, instruction and training must
include:
• The risks to health created by exposure to
ionising radiation
• The precautions to be taken
• The importance of complying with medical,
technical and administrative requirements

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 Regulation 14
Cooperation between employers
• Exchange of information required between
employers to ensure that all can comply
with the regulations

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 Regulation 16
Designation of controlled or supervised areas
• Controlled area where anyone is likely to
receive an effective dose > 6mSv per year
• Supervised area where anyone is likely to
receive an effective dose > 1 mSv per year
or where it is necessary to monitor the
conditions with a view to making the area a
controlled area

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 Regulation 17
Local rules and Radiation Protection
Supervisors (RPS’s)
• Employer to devise rules for controlled and
supervised areas
• Employer to appoint named RPS’s

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 Regulation 18
Additional requirements for designated areas
• All controlled/supervised areas to be clearly
signed
• Only designated (classified) persons shall
enter controlled areas
• Estimation of dosage for classified persons
entering controlled areas to be entered in
classified persons radiation passbook
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 Regulation 18 (continued)
• Results of measurements to kept for 2 years
and made available to individual
• Prevention of spread of contamination by
provision of washing/changing facilities,
maintenance of the facilities, prohibition of
eating/drinking and monitoring of
contamination of persons entering/leaving a
controlled area
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 Regulation 19
Monitoring of designated areas
• Adequate monitoring of radiation levels in
controlled and designated areas in addition
to personal dose monitoring

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 Regulation 20
Designation of classified persons
• Any employee likely to receive a dose >6
mSv per year must be classified and
informed
• Designated persons must be over 18 years
of age and certified by a doctor to be fit for
work with ionising radiation

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 Regulation 21
Dose assessment and recording
• Assessment for each person
• Use of approved dosimetry services
• Records to be kept until classified person
would have been 75 and at least 50 years

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 Regulation 22
Estimated doses and special entries
• If a dose meter is lost an estimate must be
made of the dose received

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 Regulation 23
Dosimetry for accidents
• If a person is likely to receive a dose >6
mSv as a result of an accident, a dose
assessment must be carried out by the
dosimetry service

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 Regulation 23
Medical surveillance
• Required for classified persons, persons
who have been overexposed and anyone
subject to medical conditions

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 Regulation 25
Investigation and notification of overexposure
• Immediate investigation required
• Executive, appointed doctor and person
exposed to be notified
• Measures taken to prevent a re-occurrence

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 Regulation 26
Dose limitation for over exposed employees
• Additional dose limitation required

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 Regulation 27
• Radioactive substances should be in sealed
source whenever reasonably practicable
• Leakage from sealed sources must be
prevented so far as is practicable
• Leakage from other sources prevented so
far as is reasonably practicable
• Leakage tests to be carried out at suitable
intervals and records kept for 2 years
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 Regulation 28
Accounting for radioactive substances
• Keep records of quantity and location for
two years
• Keep records for two years after disposal

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 Regulation 29
Keeping & moving of radioactive substances
• Must be kept in a suitable receptacle and
suitable store when not in use
• Keep in a suitable receptacle, so far is
reasonably practicable, when moved
• Does not apply to live bodies or corpses

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 Regulation 30
Notification of certain occurrences
• Release into the atmosphere
• Loss or theft of a radioactive substance

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Regulation 31
• Duties of manufacturers of articles for use
in work with ionising radiation

Regulation 32
• Equipment used for medical exposure

Regulation 33
• Misuse or interference with sources of
ionising radiation

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 Regulation 34
Duties of employees
• Not to expose themselves or others to
ionising radiation
• Use PPE & report defects etc.
• Comply with employers requirements
• Comply with medical surveillance
• Notify employer of any overdose
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Principles of Radiological
Protection
• Benefits must out way detriments
• Use smallest possible source
• Maximise distance between source
and people
• Provide adequate source shielding
• Minimise exposure time

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 Light

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 Poor Lighting

• Affects the health of people at work

• Eyestrain, migraine, headaches
• Sick building syndrome
• Lethargy, irritability, concentration

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Effects of poor lighting to
business
• Time off as a result of accidents

• Increased absenteeism

• Reduced staff efficiency &

productivity

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 Glare
• Disability glare: direct interference
with vision e.g. security light
coming on
• Discomfort glare: Vision is not
directly impaired but causes
discomfort, irritability or
distraction
• Reflected glare: due to shiny or
polished surfaces
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 Protection from glare
• Use of blinds
• Diffusers
• Louvres
• Changing work surfaces to matt
• Change relative positions of
surface, light source & viewer

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 Colour effects

• Artificial light and changing natural

light can cause colour effects

• This can affect certain tasks e.g.

involving electrical work where
colour discrimination is vital

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 Stroboscopic effects
• Lamps operating from alternating
light sources can produce
oscillations which can have the
effect of making machinery appear
stationary or moving at a different
speed

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 Flicker
• Light modulation at lower
frequencies (50Hz or less) is
known as flicker

• Can cause discomfort and fatigue

and may even cause epileptic
seizure in some people

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Problems caused by insufficient
illumination
• Irritation of the eyes and lids
• Itchiness
• Breakdown of vision
• Blurred or double vision
• Headaches, fatigue
• Poor posture

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Accidents caused by poor
lighting
• Tripping
• Being struck by moving vehicles
• Walking into structures/vehicles
• Falling from heights
• Being injured by machinery

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Chemical Hazards

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 Forms

• Dust
• Gases
• Fumes
• Liquids
• Mists
• Solids
• Vapours

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 Toxicity

The ability of a
substance to cause harm
once it reaches a site in
or on the body

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 Degree of harm

This will depend on:

• The inherent harmful properties of
the substance
• The route of entry
• The speed of entry

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 General Effects
• Effects can be acute or
chronic
• Localised at point of
entry or systemic

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 Specific Effects
• Disturbance of normal cell function
• Damage to cell membranes
• Interference with enzyme and
immune systems
• Affects on DNA and RNA activity
• Most substances end up in the liver
which attempts to convert them to
less harmful substances

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 Factors affecting toxicity
• The dose received
• The metabolism of the body
• The physical state of the substance
• The affinity for human tissue
• The solubility in human tissue
• The sensitivity to attack of the organ
• The susceptibility of the individual
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 Commonly Occurring Toxic
Substances
• Trichlorethylene - anaesthetic, skin
attack including blistering, dermatitis
• Carbon monoxide - forms
carboxyhaemoglobin
• Lead - inorganic or organic - liver
converts tetraethyl forms into triethyl
forms

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Symptoms of lead poisoning

• Fatigue
• Loss of appetite
• Metallic taste in mouth
• Constipation
• Brain and kidney damage

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 Lead poisoning

• Tetraethyl and tetramethyl lead absorbed by

the skin
• Converted to the more toxic triethyl forms
in the liver
• Statutory health surveillance including
blood tests for lead workers

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 Other common toxic substances
• Isocyanates – used in vehicle spray paints,
adhesives and foam manufacture. Known
sensitisers.

• Acids/alkalies – corrosive substances which

attack the skin, lung tissue etc.
e.g. hydrochloric acid, sodium hydroxide

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 Sensitisers
• Irritants often sensitisers
• Respiratory sensitisers most harmful and
should be avoided
• Sensitisation to a range of substances
• No way of de-sensitising

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Typical sensitisers
• Pesticides
• Isocyanates
• Tea dust
• Platinum salts
• Glutaraldehyde
• Dust/pollen from grain
• Western red cedar
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Biological Agents

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 Biological Agents
• Viruses - hepatitis, HIV, flu
• Bacteria - anthrax, legionella, leptospirosis
• Fungi - Farmers Lung, ringworm
• Nematodes - hookworm
• Protazoa – malaria
• BSE – new variant CJD

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 Hepatitis
Inflammation of the liver due to infection or
toxic substances
• A – from infected stools. Vaccine available.
Recovery usually rapid (1-2 weeks)
• B – from infected blood. Vaccine available.
Effects last from 3 – 6 months
• C – from infected blood. No vaccine.

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 Hepatitis Risk Group
A - Food handlers, hospital workers

B – Anyone handling blood or blood

products. Drug addicts.

C – As for B

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 Aids/HIV
• Acquired immune deficiency syndrome
• Human immuno deficiency virus
• Virus attacks body tissues and white cell T4
• Symptoms include swelling of glands, loss
of weight, fatigue etc.
• Opportunistic infection such as pneumonia
often fatal
• Transmitted sexually & by infected blood

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 Leptosirosis (Weil’s Disease)
• Contact with infected urine from rats
• Flu like symptoms
• Attacks liver and kidneys
• 15% mortality rate
• Those at risk include workers in abattoirs,
sewers, mines, vetinary practice & those
involved in inland water sports
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 Legionnaire’s Disease
• Bacteria existing in soil, rivers, air
conditioning systems, water systems
• Maximum growth in 20 – 50oC range
• When inhaled in fine water droplets can
cause pneumonia/flu like symptoms
• Most at risk are middle aged smokers
• 15% mortality rate
• To control keep water systems clean

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 Anthrax
• Highly infectious bacillus (rod shaped)
• Contact with animals/animal products
• Red-brown spot turns into black ulcer
• Painless but fever, headaches and swollen
glands can occur
• Responds to antibiotics – high mortality rate
• Those at risk include workers handling
animals & animal products, dockers

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Ergonomic Hazards

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 Ergonomic Principles
(See also Unit 1A2)
• Choice of correct workstations to meet the
requirements of all the workforce difficult
• In practice 10% fall outside ‘normal’ range
• Designer has to make compromises
• Employer needs to choose carefully to meet
needs of as many employees as possible

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 Ergonomic problems
• Uncomfortable seating
• Workstations with wrong height/angle
• Hand tools causing strain/vibration
• Switches/gauges badly positioned
• Badly positioned instruments
• Excessively tiring operations
• Operations requiring unnatural body
positions
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 Work related upper limb
disorders (WRULDs)
• Bursitis – inflammation of the joints caused
by repeated pressure or jolts
• Epicondylitis – inflammation of the elbow
(Tennis Elbow)
• Tendonititis – inflammation & thickening
of the tendons

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 Tenosynovitis
• Inflammation of the wrist tendon
• Caused by trauma, over use, repetitive movements
• Symptoms include aches and pains in hands,
wrists, forearms etc. followed by redness, swelling
and limitation of movement
• Important to look for early signs
• Can be permanent

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 Other WRULDs

• Back pain
• Neck pain
• Fatigue
• Carpal Tunnel Syndrome

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Tasks causing WRULDs
• Production lines with repetitive
movement
• Working with keyboards
• Working with fly presses
• Work with vibrating equipment
• Assembly work

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 Prevention

• Identify all tasks requiring repetitive

movement
• Look for early signs of problems
• Change work patterns
• Automate if possible

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Hazardous Substances

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 COSHH Definition
‘Those substances specified as very, toxic,
toxic, corrosive or irritant within the
meaning of the Chemicals (Hazard
Information & Packaging for Supply)
Regulations 1994 (CHIP2) as amended in
1996 (CHIP96)’

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 Hazardous Properties

• Explosive • Corrosive
• Oxidising • Irritant
• Flammable • Carcinogenic
• Highly flammable • Mutagenic
• Teratagenic
• Extremely flammable
• Agents of anoxia
• Toxic
• Narcotics
• Very toxic
• Harmful to the
• Harmful environment
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 CHIP 2/CHIP 96
Suppliers of chemicals must:
• Identify the hazards
• Give information about the hazards
• Package the chemicals safely
• Label the packaging to identify the contents
Suppliers include manufacturers, importers
and distributors
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 Data Sheets
• These must be provided for all dangerous
chemicals for use at work
• Must contain sufficient detail to help users
to avoid damage to health
• Must give information on how to deal with
spillage or contact
• Data sheets help with COSHH assessment
but do not form the assessment alone

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 The Carriage of Dangerous Goods by
Road Regulations 1996 (CDG)
• Carriage Requirements are imposed on
those who consign chemicals for transport
• Includes pure chemicals, mixtures,
preparations etc.
• Includes transfer by road between sites
under the same ownership

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 Labelling under CHIP 2
Each label must contain details of:
• The supplier
• The chemical name
• The category of danger
• The appropriate risk and safety phrases

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 Risk Phrases

• Summarise the main danger from a

chemical
• R45 – may cause cancer
• R23 – toxic by inhalation

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 Safety Phrases

• Tell the user what to do or what not to do

• S2 – keep out of the reach of children
• S29 –do not empty into drains

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Common Warning Symbols

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 Labelling for CDG
• Transit labels are similar to but not as
comprehensive as packaging labels
• Concentrate on information required in
event of an accident, spillage etc.
• For single substances the CHIP 2 and CDG
information can be combined into a
composite label

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Example of CDG Label

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Effects on Human Body

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 The skin

• Dermatitis
• Scrotal Cancer
• Burning
• Scarring

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 Irritative Dermatitis
• Caused by acids, alkalies, cements,
solvents, metals e.g. nickel/nickel salts
• Effect depends on concentration and
duration of exposure
• Condition can worsen with repeated
exposure

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 Sensitising Dermatitis
• Initially there is an allergic response in the tissues
• This is followed by dermatitis
• Sensitisers include chrome salts, nickel, cobalt,
epoxy plastics, formaldehyde etc.
• Sensitisation can cause a dermatitic rash even after
exposure to a small quantity of the chemical
• Some substances can act as both irritants and
sensitisers e.g. nickel

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Symptoms of Dermatitis
• Rough and sore skin
• Itchy skin
• Diffuse rash
• Localised rash
• Cracked skin
• Pain!

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Protection against dermatitis
• Barrier creams
• Moisturising creams
• Protective clothing
• Reduced exposure
• Medical advice is essential

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 Scrotal Cancer
• Caused by contact with soot, shale oil,
creosote etc.
• Chemicals involved are polycyclic aromatic
hydracarbons of the benzpyrene or
benanthracene types
• Cancer starts as a wart which ulcerates
before breaking down and spreading
malignant cells

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The Respiratory System
• Pneumoconiosis
• Silicosis
• Asbestosis
• Farmer’s Lung

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 Pneumoconiosis
• This is caused by the reaction of the lungs to the
presence of dust

• Total inhalable dust is quantity entering the mouth

and nose and which could reach the lungs

• The harmful effect is determined largely by

particle size

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 Particle size (microns) Effect

   
> 10 Filtered off by the nasal hairs or
deposited in the upper respiratory
tract
 
   
5 – 10 Tend to be trapped by the mucous
covering the bronchi and bronchioli
and dealt with via the cilliatory
escalator.
They tend to be coughed or spat out
but some will be swallowed.
   
<5 This are more likely to reach the
lung tissue and be permanently
deposited.
 

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 Respirable Dust
• ‘The amount of inhaled dust which is
capable of penetrating to the gas exchange
region of the lungs’
• Dust causes a tissue reaction in the lungs
• Asbestos tends the affect the lower lungs
and coal and silica the upper lungs

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Substances causing pneumoconiosis
• Metal dusts such as iron, tin and barium
• Beryllium
• Organic dusts
• Talc
• Cobalt
• Man made fibres such as fibreglass
• Symptoms include coughing and breathlessness

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 Silicosis
• Caused by inhalation of free silica
• Crystalline forms most dangerous
• Particles <5 microns are absorbed by the
macrophages leading to fibrous nodules
which obliterates the air sacs
• Symptoms are breathlessness and can lead
to tuberculosis

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 Asbestosis
There are three types of asbestos:

* Blue (crocidolite)
* Brown (amosite)
* White (chrysotile)

All types are covered by the Asbestos Regulations

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 Asbestosis
• Causes a fibrous thickening of the lung
• Leads to breathlessness
• Mesothelioma is a malignant tumour of the
pleura caused by exposure to asbestos,
particularly the blue and brown forms

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 Farmers Lung

• An allergic reaction caused by inhalation of

fungal spores in hay

• Causes chronic breathlessness

• Exposure to hay must be avoided

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Defense Mechanisms

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 Superficial
• The skin as a physical barrier
• Coughing/sneezing
• Spitting
• Trapping by mucous – cilliary escalator
• Lachrymation (crying)
• Ear drum and wax
• Vomiting and diarrhoea

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 Cellular Defense Mechanisms
• Blood clotting to prevent entry of bacteria
and viruses
• Phagocytosis – attack on invading
organisms by white blood cells known as
macrophages. This is part of the immune
system
• Secretion of defensive substances e.g.
Histamine

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• Inflammatory response due to increased
blood flow to damaged tissue
• Immune response which can be ‘innate’
(inborn) e.g. phagocytosis or ‘acquired’
after exposure to an invading organism
• Fibrotic response causes scarring due to
collagen (protein) fibres forming in the
damaged tissue area. Can strengthen the
tissue but can also cause problems if
scarring is in organs such as the lungs or
eyes

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