Engineered stone has approximately 90% silica compared with natural stone like marble and limestone which have around 2% silica.1 Due to an increase in the number of silica-related diseases and cases of silicosis in parts of New Zealand and Australia, the motion for change around working with engineered stone and other products that are high in silica has gained momentum over the last few years. These are linked with workplace exposure to crystalline silica dust, which becomes airborne and highly hazardous to those who are exposed to it.
Studies have shown that there is a strong correlation between those that work with materials and products that are high in silica and cases of occupational lung disease – which is significant since there is currently no cure for silicosis. And while employers have a responsibility to provide health monitoring, Bodycare believes it is important for each individual to be fully informed and aware of any risks that may be present in their own workplace setting.
What is Silicosis?
Silicosis is a long-term lung disease that is the result of the body’s response to the presence of crystalline silica (silica) particles in the lungs which penetrate deep into the lungs and is known to cause scarring, or fibrosis resulting in lung damage and disease.
The three major types of silicosis are based on the length of time and nature of the exposure to silica dust, but all affects people in the same way. They are:
- Chronic silicosis – this is the most common type of silicosis. The symptoms of silicosis develop slowly and progressively over decades with prolonged silica exposure.
- Acute silicosis – the symptoms of silicosis develop quickly from a few weeks to less than 5 years after extremely high levels of exposure to silica.
- Accelerated silicosis – the symptoms of silicosis develop more quickly than chronic silicosis, within 1 year, but less than 10 years after exposure to a large amount of silica in a short period of time. Accelerated silicosis is especially common in people who work with engineered stone benchtops.2
What Causes Silicosis?
Silicosis is preventable. Silica, a major component of most rocks and soils, can be found in a variety of materials including sandstone, quartz, concrete, plaster, grout, and mortar. Silicosis is caused by breathing tiny particles of respirable crystalline silica (RCS) dust into the lungs created when materials containing silica are cut, ground, drilled, sanded, or polished.3 Over time, the silica dust gets deposited deep in the lungs through inhalation by those exposed, leading to inflammation, and scarring of the lung tissue, causing silicosis.
Who is at Risk of Silicosis?
Because crystalline silica is most dangerous to health when it becomes airborne in the form of invisible dust, those most at risk are workers performing tasks where they are likely to inhale it. Your chances of inhaling it are also based on how much silica dust you encounter, how long you are exposed to it and your level of protection by equipment or individual resistance.
Exposure to crystalline silica may occur in several industries and occupations due to its wide and varied use. You might be at risk of developing silicosis if your work involves the production of respirable silica dust particles through:
- fabrication and installation of composite (engineered or manufactured) stone countertops
- excavation, earth moving and drilling plant operations
- clay and stone processing machine operations
- paving and surfacing
- mining, quarrying and mineral ore-treating processes
- tunnelling
- construction labouring activities
- brick, concrete or stone cutting; especially using dry methods
- abrasive blasting
- foundry casting
- angle grinding, jackhammering, and chiseling of concrete masonry
- hydraulic fracturing of gas and oil wells
- pottery making.
What are the Symptoms of Silicosis?
Awareness of any previous or current exposure to hazardous agents in your occupational history is important when thinking about lung diseases such as silicosis. This is because its symptoms may not be noticeable until the disease has progressed, and it may be hard to detect in the early stages (except in acute silicosis).
The symptoms – which become more severe as the condition worsens – include shortness of breath after exercising, chest pain, dry or productive (sputum) cough, wheezing, tiredness, and weight loss.
Silicosis can also increase the risk of getting other serious conditions such as tuberculosis, chest infections, emphysema, kidney damage and lung cancer.
How is Silicosis Diagnosed?
Symptoms of silicosis and progressive massive fibrosis may not appear for many years after exposure. This means that workers may be diagnosed with these diseases and not present with any symptoms, even at the point of initial diagnosis, which is why health monitoring is so critical.
Health testing for exposure to crystalline silica can be conducted before an employee is onboarded so that a baseline can be established and any changes to the worker’s health after commencing work can be detected.
Health monitoring required for respirable crystalline silica (RCS) involves a registered medical practitioner with experience in health monitoring examining and monitoring the health of workers to see if exposure to hazardous chemicals at work is affecting workers’ health.
From the initial health monitoring date, a worker’s health should then be monitored annually through health surveillance. Where workers are exposed, suspected of being exposed or are concerned about exposure to crystalline silica, the person conducting the business or undertaking (PCBU) has a duty to arrange a health monitoring appointment for the worker(s) with a registered medical practitioner annually.
The first step to diagnosing silicosis is a discussion with your general practitioner, who will gather information on your medical history, work history and any symptoms you may have. To confirm a diagnosis, you may be referred to a respiratory specialist or occupational specialist doctor.
Through visits with these medical professionals, you may undergo several tests, including:
- Physical examination
- Lung function (breathing tests)
- Chest X-ray
- High-resolution CT scan (HRCT)
- Arterial blood gas analysis
- 6-minute walk test.
If a diagnosis cannot be made through medical and occupational history and radiological imaging, some further tests such as a diffusing capacity of the lungs for carbon monoxide (DLCO), bronchoscopy, endobronchial ultrasound and a biopsy may be required.4
How is Silicosis Treated?
Although silicosis cannot be cured, there are several management strategies available to help reduce symptoms and potentially slow the progression of the disease.
These include:
- Medications like relievers which help to open the airways and make breathing easier.
- Oxygen therapy which may be prescribed if you have low blood oxygen levels.
- Lung transplantation may be recommended for an eligible candidate in the case of severe silicosis which is worsening.
- Whole lung lavage or ‘washing out’ of the lung using several liters of salt-water solution, with the intention of flushing out the damaging silica crystals. This procedure is currently in the trial phases.
Your doctor may also suggest you stop smoking (if you smoke), have regular tests to check for tuberculosis and have the annual flu vaccine administered.
How is Silicosis Prevented?
Since silicosis is irreversible with limited effective treatments available, prevention is key. As such, the only way to protect workers from developing silicosis is to control their exposure to silica-containing materials and dust. Workplaces have a duty to undertake independent assessments of personal workplace respirable crystalline silica dust levels, and all efforts must be made to reduce these levels.
If you are working with, or are exposed to silica dust, here are a few things you can do yourself to protect your lungs and reduce your own risk:
- Follow the Hierarchy of Controls/ health and safety advice – this refers to actions your employer must take to eliminate or minimise health and safety risks, which you have a responsibility to follow.
- Participate in health monitoring – also known as health surveillance, it is mandated under Health and Safety legislation. This aids in detecting early signs of silicosis in workers. (share details and specifications of occupational history).
- Know and report the symptoms – this will help with identifying impacted health sooner.
- Talk to your doctor – regular check-ups with a medical professional are important, even if you are not experiencing any symptoms.
- Quit smoking or vaping – this will only increase your risk of many lung diseases.
- Practice good hygiene – wash your hands before eating and drinking and put any dusty clothing in a separate wash basket.
Source: Lung Foundation Australia (2021)
How does Silicosis Impact Lives?
Each person experiences silicosis differently. Some people remain stable for many years whereas others may face a rapid decline. Either way, early detection, and reduction of further exposure to silica dust is vital. However, this may mean leaving your job or even your industry, which can be very disruptive to your livelihood. The financial loss from change in work can also be a challenge for people living with silicosis. Depending on the state or territory, some compensation schemes may assist with medical expenses, loss of income or compensation for pain and suffering.
As well as physical health, silicosis can significantly impact your mental health and emotional wellbeing, as your family navigates a ‘new normal’4. It is equally important to access mental healthcare early so that you have a trusted source of support to turn to.
Silicosis Statistics
It is estimated that around 600 current and former workers in New Zealand who fabricate engineered stone are at risk. New Zealand imports about 60,000 engineered stone slabs annually, and authorities are aware of more than 130 businesses that fabricate it into benchtops. As at the end of February 2023, 140 claims had been lodged with ACC for assessment.5 This number is predicted to rise in this industry as well as others, and so restrictions around protecting at-risk employees must continue to be tightened.
Bodycare offers health surveillance services that can take place onsite or offsite through a national clinical network depending on your organisation’s individual needs. Reach out to our team for more information, visit our website at www.bodycarenz.co.nz or email us at admin@bodycarenz.co.nz.
Read the Australian version of this article here.
Sources
1 WorkSafe – Silica dust in the workplace
2 Health Navigator New Zealand – Silicosis
3 WorkSafe – 8 key things for workers to know: Controlling silica dust in the workplace
