• Introduction
• Factors that influence the level of risk
• Action to be considered by all inspectors and LA enforcement officers

1 Introduction

1  People who may have been exposed to asbestos are understandably anxious and concerned about the possible effects on their health. Moreover, where incidents involve members of the public or vulnerable sections of the population, widespread publicity may result. HSE/FOD frequently receives requests from employers, employees, trade unions, other interested parties and members of the public for advice on how to manage the health aspects of such exposure. This OC gives LA and HSE staff, particularly specialist group medical and occupational health inspectors, advice on how to deal with such requests consistently.

2  There is at present no effective post-exposure prophylaxis for the effects of inhaled asbestos fibres, although in smokers the risk of asbestos-induced lung cancer (but not mesothelioma) can be reduced by stopping smoking. There are also no generally available techniques for determining individual lung burdens of asbestos fibres, other than post mortem.

3  HSE does not advocate routine X-rays for people exposed to asbestos in the majority of such circumstances. (Asbestos-related damage to the lungs takes years to develop and become visible on chest X-rays, and X-ray examinations cannot indicate whether or not asbestos fibres have been inhaled.)

2 Factors that influence the level of risk

4   Inhalation of asbestos fibres can lead to very serious diseases such as mesothelioma and lung cancer in later life. Much of the current burden of asbestos-related disease (about 4000 deaths per year) is a result of past heavy industrial exposures among those who manufactured and installed asbestos products. However, HSE is now concerned about lower exposures that may still lead to disease, particularly since specific exposure incidents could form part of a pattern of repeated exposure among some workers (such as electricians, plumbers and carpenters), leading to a substantial cumulative exposure.

5   We are all exposed to a low level of asbestos fibres because asbestos was such a widely used material within buildings, machinery, vehicle brakes and homes until 1999, when most forms of asbestos were banned.  However, working directly with asbestos containing materials (ACMs) can give personal exposures to airborne asbestos that are much higher than environmental levels.  Repeated exposures of this type will give rise to a substantial cumulative exposure, thereby increasing the risk of developing an asbestos related disease in the future. The aim of the Control of Asbestos Regulations 2006 is to prevent or reduce additional work-related exposure to asbestos fibres. 

6  More detailed guidance on the factors that impact on the level of risk from the differing types of exposure patterns are detailed in section 3 of ID(1)

3 Action to be considered by all inspectors and LA enforcement officers

7  Asbestos incidents arouse concern and anxiety, and often unrealistic expectations of medical tests or even treatment. This should be addressed by offering prompt and reasoned advice, without contributing to unnecessary alarm. The guidance in this circular and the IDs should be sufficient in many cases and is intended to assist those responsible for managing such situations.

8  In circumstances where cases of exposure to asbestos may have occurred, the following issues should be considered:

1. Ascertain as far as possible the type of asbestos, the likely exposure levels involved and the duration of exposure.  Consult with an occupational hygiene inspector to provide a context of overall life-time risk that includes the alleged exposure.
2. Whether enforcement action is appropriate where there is sufficient evidence to show a significant exposure. Please note section 3 of ID(1). Enforcement guidelines can be found in OC265/50
3. Whether the incident is reportable as a Dangerous Occurrence to HSE’s Incident Contact Centre (Tel: 0845- 3009923).  Examples of types of work that could be classified as a Dangerous Occurrence are listed in Section 3.1 of ID(1).
4. That the duty-holder has considered how to prevent a re-occurrence of the circumstances that led to the incident.
5. Employers asking about retention of records should be advised that, under the Control of Asbestos Regulations 2006, they are not required to retain health records for those working with asbestos, unless they carry out licensed work.  Health records for employees of licence-holders should be retained for 40 years.
6. Consider offering those involved: employers, employees or members of the public, the opportunity to discuss the situation with a medical or occupational health inspector, particularly where they are otherwise unlikely to have access to an occupational health service.
7. Advise employees that if they wish to consult their GP's they should ask for a note to be made in their personal record of the possible exposure including date(s), duration, type of fibre, and likely exposure levels (if known). Advise them that their GP may refer them to a specialist in respiratory medicine in some circumstances, but that this is not considered necessary by HSE in most cases.
8. Providing employers with a list of occupational health services from EMAS if they choose to refer employees for assessment and counselling.
9. Liaising with the Director of Public Health/Director of Environmental Health, via a medical inspector, in circumstances where concerns are raised about off-site effects and risks to members of the public.
10. The provision of the relevant Information Document for employers ID (1)), employees and member of the public (ID (2)), and GP's ID (3)).is available.