As we enter a new decade it is an opportune time to reflect on the decade we are about to leave and take stock. In our professional life, what drives many of us is the desire to protect the workforce so that they go home at night safe and sound. In so doing we need to ask ourselves a question – how much have we really achieved over the past decade in doing our bit to ensure we protect workers from work-related lung disease?
What do the figures tell us?
Looking at HSE’s statistics on work-related ill health and workplace injury we see a mixed picture. Thankfully there is a clear downward trend on self-reported non-fatal injuries over the past 20 years and, since 2000/01, the estimated rate of non-fatal injury to workers has fallen by around a half. The statics on fatal injuries, while showing a massive 84 per cent decrease since 1984, has over recent years (2014/15- 2018/19) remained broadly static.
On health, there continues to be a substantial increase in the number of deaths due to past exposure to asbestos and this is expected to continue for the short term. Deaths due to exposure to respirable crystalline silica have seen a steady decline over the past decade. However, the statistics on new cases of occupational lung diseases tells a different story. Over the past decade the number of work-related breathing or lung related problems has remained broadly constant. In 2018/19, an estimated 42,000 workers in Great Britain were suffering from a work-related breathing or lung problem (either new or long-standing) and approximately 18,000 new cases of work-related breathing or lung related problems are reported on average (based over the past three years). So clearly, there is room for improvement.
Comfort of respiratory protective equipment (RPE) is a major factor in whether the RPE is worn correctly and when needed. Wearers often complain that their RPE is uncomfortable – too hot, too warm, hard to breathe through, doesn’t fit, too heavy and so on, and for our modern diverse workforce these parameters are of increasing importance. If we aren’t addressing these concerns with energy, then we are failing the UK workforce. Looking at the choice of RPE now available shows that we are indeed taking comfort seriously, but there is still some way to go.
The breathing resistance of RPE is a major contributor to wearer comfort. If wearers find that their RPE is difficult to breathe through they may be more inclined to either not fit it correctly or cease to use it. Exhalation of warm and moist air is often an issue for wearers as it can increase heat and moisture build up within the RPE. Recent innovations in exhalation valve design have started to make inroads in reducing heat and moisture build-up in addition to reducing exhalation breathing burden.
Developments in filter technology, both mechanical and electrostatic, over the years has resulted in high filtering efficiencies with lower breathing resistances. Today’s diverse workforces, and the introduction and growth of fit testing, now demands an expanded shape and size range of facepieces – particularly towards the smaller size. Larger mask sizes provide scope for increasing the filter surface area, thus keeping breathing resistance low, but for smaller facepieces novel solutions are required to continue to reduce breathing burden.
Often when there is a need for RPE there is also a requirement for other forms of protection – for the eyes, the ears, or the head. With each of these fighting for the same space on the head/face, compatibility is a challenge. Health and safety managers need to ensure that each item doesn’t reduce the protective performance of the other. Integrated solutions offering respiratory, eye, face, head and hearing protection (with some now offering communications as well) provide an effective choice, but that may not always be the right option for some applications. Further compatibility improvements should also remain an ongoing design focus.
Fit and fit testing
Fit is a crucial element of comfort. A hard to fit, poorly fitting, tight-fitting facepiece or even an uncomfortable loose-fitting headtop can be a barrier to proper use resulting in a reduction of protection. Innovations over the past decade have seen the introduction of enhanced fit designs with comfort strips and face seals, sculptured face seals for improved fit, as well as better compatibility with eyewear, softer and more flexible designs to allow greater facial movement, while maintaining effective fit. Recent facepiece designs and the integration of smart technology help the wearer to conduct an effective fit check, which is a crucial step every time a facepiece is donned.
These are all positive steps in the right direction, but as facepiece fit is so crucial to achieving effective protection, further fit enhancements across that range of RPE should continue to be a priority.
With the support of HSE and through the Fit2Fit scheme, competent fit testing is now an accepted part of the journey to select suitable RPE. Although we don’t yet have 100 per cent compliance in that all wearers of tight-fitting respirators are fit tested, adoption is growing and inclusion of fit testing and fit test training in RPE provision and service tenders, is helping to drive compliance.
Fit testing has also contributed to the increase in the range of options available. Diversity in mask shapes and sizes means that now is it just about possible to find a good fitting facepiece for every wearer.
Not only does fit testing help to select suitable respirators, it also provides an ideal opportunity for one-to-one training for wearers to raise awareness of the respiratory hazards in the workplace, to reinforce the message of the importance of correct fitting, provide training on donning techniques and address compatibility with other items of PPE (other head worn PPE should be worn during the fit test) – and of course talk about facial hair (see below). Lack of knowledge on how to don a respirator and lack of care taken during the donning procedure are two of the most common reasons why people fail a fit test the first time – but, with key lessons learnt, many then go on to pass at the second attempt.
The Fit2Fit scheme was pioneering and it is great to see the influence it has had on a global scale. Fit testing competence schemes are now established, or in the process of becoming established, in the Netherlands, Belgium, and as far away as Australia.
Tight-fitting respirators must achieve a leak tight seal to the wearer’s face to help provide effective protection. If the seal is compromised by facial hair, then the wearer may be exposed to harmful airborne contaminants. Wearer facial hair is perhaps the most commonly cited issue regarding respirator selection, use and fit testing. It can be a highly contentious issue, touching on wearers’ rights, employment law, religious beliefs and employer responsibilities. The rights of the wearer need to be balanced against the need to protect the health and safety of the wearer – a balance that can be tricky to achieve in some circumstances. But there are solutions – for wearers with facial hair there are many loose-fitting respirators from which to choose that will provide the required level of protection. These also can provide a great solution to improving PPE compatibility as options are now available that can offer combined respiratory, eye, face and hearing protection.
Smart technology has a lot of offer both wearers and health and safety managers. One of the challenges faced in respiratory protection is knowing the level of protection being provided by an item of RPE when in actual use in the workplace. Conducting workplace protection factors studies are complex and costly, so if the future holds out the possibility of having real-time performance feedback that will be a great achievement. Smart technology is starting to create opportunities for assessment of fit, location tracking, and real-time monitoring of wear, breathing rate and end of filter service life indication. Smart and connected technology is opening many new and exciting ways to improve respiratory protection across all its elements – selection, provision, use, maintenance and training.
So, what should we expect to see over the next decade? Unfortunately, we can’t predict the future, but one thing we do know, is that we need to continue to design more comfortable RPE, embrace new technology into products, training and use, and continue to grow respiratory hazard awareness. Of course, for proper exposure control, we need to follow the hierarchy of controls with elimination and substitution being at the top; however, there will always be a need for RPE. When we give wearers the benefits from innovation – in product design, in use and in training, this will ultimately lead to improved protection and, hopefully, we will start to see a reduction in the statistics on work-related ill health.
- HSE 2019. Historical picture statistics in Great Britain, 2019 Trends in work-related ill health and workplace injury. www.hse.gov.uk/statistics/history/historical-picture.pdf
- HSE2015. RR1052 The effect of wearer stubble on the protection given by Filtering Facepieces Class 3 (FFP3) and Half Masks. www.hse.gov.uk/research/rrhtm/rr1052.htm