skin problems in the printing industry

skin problems in the printing industry

Introduction This leaflet has been produced by the Printing Industry Advisory Committee (PIAC) to give practical guidance about how to prevent skin problems, particularly dermatitis, in the printing industry. Dermatitis is a serious and costly problem in printing. Of 1189 printers involved in a recent study, 41% had suffered from a skin complaint at some time and 10% had a current problem. Of the skin problems diagnosed, 58% were work-related. PIAC believes that there is a need for better recognition and understanding of the disease, better skin-care provision and more rigorous monitoring and surveillance to deal with problems in the early stages. Effective management of the simple steps required to prevent the disease would help reduce the number of dermatitis cases. How does dermatitis develop? Dermatitis occurs when a substance penetrates the surface layer of the skin and provokes a reaction from the vulnerable skin beneath. Refer to the booklet HSG205 Assessing and managing risks at work from skin exposure to chemical agents if you would like to know more about how dermatitis develops. What are the symptoms? Symptoms can include redness, rough skin or a rash, spots, swelling, thickening of the skin with scaling, tiny water blisters or oozing, wheals, welts or hives, burning, prickling or stinging, cracks or crusting, dry skin with flaking, itching, numbness in the finger tips, pain or tenderness and pus spots. 2

The most commonly affected parts of the body are the fingers and the webs between the fingers, closely followed by the back of the hands. The wrist, elbows and forearms can also be affected. Skin exposure from contact with contaminated clothing or transfer of chemicals by hand can result in other parts of the body, such as the chest, legs and face, being affected. 3

Substances that can aggravate a skin condition Wash-up solutions Hand cleansers Inks and cleaning solvents UV varnishes and inks Developers Thinners Processes with a high occurrence of dermatitis Use of materials containing isocyanates Cleaning of litho rollers and cylinders Handling pressroom consumables Platemaking Correction of litho plates Solvent use UV-cured ink use Guillotining What does the law require? Under the Control of Substances Hazardous to Health (COSHH) Regulations 1999 and the Management of Health and Safety at Work Regulations 1999, employers must make an assessment of the risks to any employees liable to be exposed to substances hazardous to health. Employers should refer to the guidance given in Control of chemicals in printing: COSHH essentials for printers when taking action to assess the risks. Any employer who receives a diagnosis of occupational dermatitis in writing by a medical practitioner must report it straight away as required by the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995, regardless of whether the person affected has or has not been absent from work. Management action The management of health risks like dermatitis within the workplace is often neglected or fails. Unlike safety issues, health risks tend to be less obvious and less well understood. Because the onset of ill health is often delayed, the risks can be underestimated until it is too late and permanent damage has occurred. 4

Practical action by management is the key to the prevention of dermatitis. Develop and implement your own action plan as follows: Action plan Assess the jobs where exposure is likely. Eliminate or substitute harmful substances. Introduce engineering controls using Control of chemicals in printing: COSHH essentials for printers. Make sure equipment for personal use, such as gloves, gauntlets or aprons, is carefully selected, worn, maintained and replaced. Make sure employees: have been taught safe working practices; use the controls provided; have been trained to use equipment for personal use; know how to check their skin; understand the benefits and limitations of pre-work skin creams. Ensure that after-work and moisturising creams are used. Appoint a responsible person to carry out skin inspections and act on any findings. Provide a management system that checks that all of these actions are carried out in practice. Preventing/avoiding dermatitis It is always better to prevent a disease rather than have to cure it. If you can get rid of the potential problem altogether by eliminating the substance that might cause harm, then this is the best and simplest solution. Where this is not possible, substitution with less harmful substances is the next step. Take action to introduce engineering controls if substances that may cause harm continue to be used. These controls should be effective in minimising the risk of exposure - this might involve the enclosure or modification of a process. The main ways of achieving this for the most common tasks in printing have been set out in the guidance booklet Control of chemicals in printing: COSHH essentials for printers. Make sure employees use the controls provided. 5

Equipment for personal use After taking action to eliminate, substitute and introduce controls, some risks may remain. Employers have further legal duties to provide suitable equipment for personal use where this is needed, as a last resort, to protect the wearer. Selecting suitable gloves Glove selection is a complicated process and employers should always seek expert help from the manufacturer or supplier of the chemical agent or glove. However, there are four basic requirements that must be met for any protective glove to be suitable: It must be appropriate for the risk(s) and conditions where it is used. It must take into account the ergonomic requirements (meaning the likely body position in which the person will be working, which may, for example result in substances dripping inside the glove if it is not suitably designed or correctly worn) and state of health of the wearer. It must fit the wearer correctly. It must either prevent or control the risk involved without increasing the overall risk. Table 1 A guide to choosing glove materials Chemical group Glove material Natural rubber Nitrile rubber Neoprene TM Water-based substances, - - weak acids/alkalis Oils - - - - - Chlorinated hydrocarbons - - - - - Aromatic solvents - - - - - Aliphatic solvents - - - - Strong acids - - - - - Strong alkalis - - - - - PCBs - - - - - PVC Butyl Viton TM 6

Table 2 A guide to choosing glove materials for specific solvents SOLVENT FIRST CHOICE SECOND CHOICE Acetone Butyl see note 1 Butanol Nitrile Neoprene TM Ethyl acetate Butyl Nitrile see note 2 Ethylene glycol Butyl Natural rubber/ Neoprene TM see note 2 n-hexane Viton TM Nitrile see note 2 Isopropyl acetate Butyl Nitrile Methanol Butyl Nitrile Methyl ethyl ketone Butyl Neoprene TM Methylene chloride Viton TM see note 3 Perchloroethylene Viton TM Nitrile Styrene Viton TM Butyl Toluene Viton TM Nitrile see note 2 Trichloroethylene Viton TM Nitrile see note 2 White spirit (Stoddard solvent) Nitrile Neoprene TM Xylene Viton TM Nitrile see note 2 Notes 1 No other material suitable for selection. 2 Severe degradation will occur to this material and will limit the use of gloves to short periods only. 3 No material will provide more than short-term protection against methylene chloride. For exposures to a combination of methylene chloride and methanol as found in paint stripper, there are no materials to offer more than short-term protection. 4 The importance of using a material from the first choice column depends on the extent of the chemical contact. If workers gloves are significantly contaminated for extended periods then the first choice glove material may be required. If, however, there is only occasional splashing of chemicals onto the glove, then the second choice glove material may be adequate. The extent of exposure will be different in each workplace and should be identified as part of your risk assessment. 5 Other factors which also must be considered are the manual dexterity required for the job and how long the glove needs to be (ie will gauntlets be necessary). If workers cannot do their job because the gloves are too thick or stiff, then they may decide not to wear them. 7

When to replace gloves Stop wearing the gloves if they are punctured or degraded or when a change in appearance (colour, elasticity or shape) occurs. These factors, together with poor maintenance, can all have a direct influence on the standard of protection predicted by the glove manufacturers. As a general rule, glove protection levels can be reduced by up to 75% when the gloves are in active use. The time after which a worker needs to change the glove, therefore, should never exceed the manufacturer s stated breakthrough time. It is important to replace gloves before protection is lost altogether. Use protective gloves correctly If protective gloves are not used correctly then they can actually increase the risk to the wearer. For example, substances may get inside the glove and contaminate the skin. Employers need to take action to train everyone who wears protective gloves in how to look after them, the correct methods for putting them on, wearing them and taking them off. When appropriate, for example when the glove surface has become contaminated by a substance, wearers should be taught to clean gloves thoroughly using a clean cloth, or wipe and dry them before taking them off to prevent the chemical contaminating the inside surface of the glove. DO NOT USE SOLVENTS TO CLEAN GLOVES Pre-work creams Pre-work creams should not be relied upon for primary protection. No one knows how quickly chemicals can get through the creams. Most people miss areas of skin and it is difficult to know when the barrier has been removed, damaged or thinned. However, the advantage of pre-work creams is that they can make the removal of dirt easier. After-work creams and moisturisers Management should ensure that after-work creams and moisturisers are applied to the skin. The use of after-work creams can be particularly beneficial. The surface layer of human skin is only the thickness of tissue paper and needs to contain enough moisture to function properly. After-work creams help to restore that moisture to the skin. 8

Skin inspection It is important to be on the lookout for problems in a systematic and regular way this is called health surveillance. Appoint a responsible person to check for skin damage and record answers on simple questionnaires about symptoms. This can be supplemented (but not replaced) by teaching employees to check their own skin and report any problems. Appointing a responsible person The responsible person can play an important role and needs to be carefully selected: They should have experience of the working environment and be able to gain the confidence and co-operation of employees. They should have enough knowledge and training to enable them to actively encourage good working methods. They should be trained by an occupational health professional to carry out skin inspections and identify straightforward signs and symptoms caused by working with certain substances or processes. They must not be expected to diagnose the possible cause of symptoms and should refer all suspected cases of dermatitis to the occupational health professional. They should report their findings to their employer who will be responsible for ensuring that any necessary action is taken. Questionnaire and frequency of skin inspection An occupational health professional should determine the nature and frequency of the surveillance and the design of a suitable questionnaire. A monthly routine is usually appropriate. It may be necessary to increase the frequency in 9

borderline cases where it is not certain whether exposure might be causing harm. Where it is clear that the risk has declined to a very low level because of changed work practices or the introduction of new technology then you may relax the frequency of surveillance. Health records Health records should as a minimum contain: surname; forenames; sex; date of birth; permanent address; National Insurance number; the date the employee started their present job; a historical record of jobs involving exposure to hazards for which health surveillance is required during the current spell of employment; the conclusions of health surveillance procedures and the date on which and by whom they were carried out. Monitoring of skin problems Employers need to actively manage the system developed for the prevention of dermatitis and other skin problems. Management should check that all stages of the action plan have been fully and properly implemented. Systematic monitoring by management should be undertaken to ensure that all aspects of the system are effective and continue to be carried out in practice. 10

References The Printer s guide to health and safety (Second edition) HSE Books 2002 ISBN 0 7176 2267 3 Control of chemicals in printing: COSHH essentials for printers HSE Books 2000 ISBN 0 7176 1835 8 Assessing and managing risks at work from skin exposure to chemical agents: Guidance for employers and health and safety specialists HSG205 HSE Books 2001 ISBN 0 7176 1826 9 Cost and effectiveness of chemical protective gloves for the workplace: Guidance for employers and health and safety specialists HSG206 HSE Books 2001 ISBN 0 7176 1828 5 Choice of skin care products for the workplace: Guidance for employers and health and safety specialists HSG207 HSE Books 2001 ISBN 0 7176 1825 0 Health surveillance at work HSG61 (Second edition) HSE Books 1999 ISBN 0 7176 1705 X The prevalence of occupational dermatitis amongst printers in the Midlands CRR307 HSE Books 2000 ISBN 0 7176 1900 1 Medical aspects of occupational skin disease Guidance Note MS24 HSE Books 1998 ISBN 0 7176 1546 6 General COSHH ACOP (Control of substances hazardous to health) and Carcinogens ACOP (Control of carcinogenic substances) and Biological agents ACOP (Control of biological agents). Control of Substances Hazardous to Health Regulations 1999. Approved Codes of Practice L5 (Third edition) HSE Books 1999 ISBN 0 7176 1670 3 While every effort has been made to ensure the accuracy of the references listed in this publication, their future availability cannot be guaranteed. 11

Further information HSE priced and free publications are available by mail order from HSE Books, PO Box 1999, Sudbury, Suffolk CO10 2WA Tel: 01787 881165 Fax: 01787 313995 Website: www.hsebooks.co.uk (HSE priced publications are also available from bookshops.) For information about health and safety ring HSE s InfoLine Tel: 08701 545500 Fax: 02920 859260 e-mail: hseinformationservices@natbrit.com or write to HSE Information Services, Caerphilly Business Park, Caerphilly CF83 3GG. You can also visit HSE s website: www.hse.gov.uk This leaflet was prepared by the Printing Industry Advisory Committee and has been agreed by the Health and Safety Commission. It contains notes on good practice which are not compulsory but which you may find helpful in considering what you need to do. Photos courtesy of St John s Institute of Dermatology, London This leaflet is available in priced packs of 15 from HSE Books, ISBN 0 7176 2322 X. Single free copies are also available from HSE Books. This publication may be freely reproduced, except for advertising, endorsement or commercial purposes. First published 03/02. Please acknowledge the source as HSE. IACL101(rev1) 03/02 C350 Printed and published by the Health and Safety Executive