Health and Safety
Executive / Commission
Local authority circulars
To: Directors of Environmental Health/ Chief Environmental Health Officers of London, Metropolitan, District and Unitary Authorities and Chief Executives of County Councils.
For the attention of: Environmental Services / Trading Standards / Fire Authorities / Other
This circular gives advice to local authority enforcement officers
| Health and Safety Executive | Operational Circular | ||
| OC 265/48 |
| Review Date | 06/11/2010 | Open Government Status | Fully Open |
|---|---|---|---|
| Version No & Date | LA version | Author Unit/Section | LAU |
HEALTH EFFECTS OF INADVERTENT EXPOSURE TO ASBESTOS: GUIDANCE FOR FOD STAFF WHEN RESPONDING TO ENQUIRIES
1 From time to time circumstances arise in which people are inadvertently exposed to asbestos fibres, usually in small quantities, in a variety of situations; examples have included: office workers exposed to asbestos dust during renovation work which disturbed asbestos ceiling tiles, council workers possibly exposed to asbestos dust whilst performing routine maintenance on air ducted central heating systems in residential flats and staff and pupils of a secondary school potentially exposed to asbestos, again from damaged ceiling tiles.
2 Those exposed receive little or no prior warning of the possible risk to health. In many cases those responsible for the exposure claim to have been unaware of the presence of asbestos prior to the work being carried out.
3 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 FOD staff, particularly specialist group medical and occupational health inspectors, advice on how to deal with such requests consistently. 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.
4 In many cases exposure will have been minimal, with little likelihood of any long-term ill-effects. However, although the type of asbestos may be known, there will often be little if any reliable quantitative information concerning the level and duration of exposure. Work with asbestos cement is unlikely to pose the same risks as work with asbestos insulation and coating and asbestos insulating board.
5 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.
6 In circumstances where cases of inadvertent exposure to asbestos may have occurred, the following steps should be considered by FOD staff:
(1) Ascertain as far as possible the type of asbestos, the likely exposure levels involved and the duration of exposure.
(2) Where employees may have been significantly exposed (for instance exposure may have exceeded the relevant action level), the employer should be advised to obtain advice from an occupational health service provider, particularly regarding the medical assessment and counselling of exposed employees.
(3) Consider offering those involved - employers, employees or members of the public, the opportunity to discuss the situation with an SG medical or occupational health inspector, particularly where they are otherwise unlikely to have access to an occupational health service.
7 In such circumstances, SG medical and occupational health inspectors should consider giving the following advice:
(1) Employers should keep accurate and detailed records concerning the incident and those persons involved. If they ask about retention of records, they should be advised that under the Control of Asbestos at Work Regulations 1987 (CAW Regulations) employers are required to maintain health records relating to employees whose exposure to asbestos exceeds the action level for 40 years and employers may wish to follow these requirements as good practice.
(2) Where exposure is unlikely to have exceeded the action levels it will usually have been insufficient to pose a significant long-term risk to health. Where the exposure can be estimated the advice given will need to reflect as far as possible the likely degree of risk.
(3) Advise employees that if they wish to consult their GPs 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.
(4) Alternatively, or in addition, employers may be provided with a list of occupational health services if they choose to refer employees for assessment and counselling.
(5) In circumstances where concerns are raised about off-site effects and risks to members of the public, the SG should liaise with the Director of Public Health/Director of Environmental Health as appropriate.
(6) 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.)
8 Information which may usefully be copied and issued to employers (ID (1)), employees (ID (2)) and GPs (ID (3)) is attached to this OC. ID (3) is intended for issue to GPs and other health care professionals only.
| Health and Safety Executive | Information Document |
|---|---|
| HSE 265/48 (Part 1) |
1 This guidance is issued by the Health and Safety Executive. Following the guidance is not compulsory and you are free to take other action. But if you do follow the guidance you will normally be doing enough to comply with the law. Health and safety inspectors seek to secure compliance with the law and may refer to this guidance as illustrating good practice.
2 Breathing in asbestos fibres can eventually lead to a number of diseases, including:
(1) asbestosis or fibrosis (scarring) of the lungs,
(2) lung cancer; and
(3) mesothelioma, a cancer of the inner lining of the chest wall or abdominal cavity.
It is possible that repeated low-level exposures may lead to asbestos-related diseases, although high exposure for long periods is linked more clearly to these diseases. There is usually a long delay between first exposure to asbestos and the first symptoms of disease; this can vary between 15 and 60 years.
3 It is unfortunately not uncommon for people to be inadvertently exposed to asbestos fibres, usually in small quantities, during building operations, maintenance work or following damage to asbestos-containing materials. (Many of those suffering today from asbestos-related diseases worked in the building trades and were exposed to asbestos in their day-to-day work with asbestos materials or because work with asbestos was carried out near them.)
4 Such incidents understandably cause anxiety about the possible effects, both short and long term, of the exposure. In many circumstances exposure will have been minimal, with little likelihood of any long term effects. Unfortunately, although the type of asbestos involved may be known there is often little, if any, reliable information concerning the amount of asbestos which may have been inhaled.
5 It is important to ascertain as far as possible the type of asbestos, the duration of exposure and the likely exposure levels. You may need to seek advice from occupational hygienists or occupational health specialists. The local office of the HSE may be able to give general advice and provide information on the availability of local specialist services.
6 You should keep accurate and detailed records concerning the incident and those persons involved. The Control of Asbestos at Work Regulations require records to be kept for 40 years. Although these Regulations may not apply, you may wish to follow their requirements.
7 If exposure is unlikely to have exceeded the action level it will usually have been insufficient to pose a significant long-term risk to health. Where you are able to estimate the extent of exposure the advice that those who have been exposed can be given should reflect the risk as far as possible.
8 Exposed individuals should be informed that if they wish to consult their GP they should ask for a note to be made in their personal medical record of the possible exposure including date(s), duration, type of fibre and likely exposure levels (if known). (Their GP may refer them to a specialist in respiratory medicine but this is not normally considered necessary by HSE.) Each case should be considered on its merits, but HSE does not normally advocate routine X-rays for persons exposed to asbestos in these circumstances.
9 Alternatively, or in addition, you may choose to refer employees for counselling. You may wish to select an occupational health service for this purpose. The local office of HSE's Employment Medical Advisory Service may be able to provide information on services in the area.
10 You should, in addition, consider carefully what went wrong in causing your employees to be exposed to asbestos on this occasion, and how you will prevent this happening again in future.
11 For those working in building maintenance, repair and refurbishment HSE publish 2 information booklets available in priced packs of 10:
(1) Managing asbestos in workplace buildings (INDG223); and
(2) Working with asbestos in buildings (INDG289);
and a pocket card:
(3) Asbestos alert: workers' card for building maintenance, repair and refurbishment workers (INDG188P).
All are available from:
HSE Books,
PO Box 1999,
Sudbury,
Suffolk,
CO10 6FS
Tel: 01787 881165 or Fax: 01787 313995
November 2000
| Health and Safety Executive | Information Document |
|---|---|
| HSE 265/48 (Part 2) |
1 This document contains advice following inadvertent exposure or possible inadvertent exposure to asbestos. People who may have been exposed to asbestos are understandably anxious and concerned about possible effects on their health.
2 Breathing in asbestos fibres can eventually lead to a number of diseases, including:
(1) asbestosis or fibrosis (scarring) of the lungs;
(2) lung cancer; and
(3) mesothelioma, a cancer of the inner lining of the chest wall or abdominal cavity.
It is possible that repeated low-level exposures may lead to asbestos-related diseases, although high exposure for long periods is linked more clearly to these diseases. There is usually a long delay between first exposure to asbestos and the first symptoms of disease; this can vary between 15 and 60 years.
3 It is unfortunately not uncommon for people to be accidentally exposed to asbestos fibres, usually in small quantities, during building operations, maintenance work or following damage to asbestos-containing materials. (Many of those suffering today from asbestos-related diseases worked in the building trades and were exposed to asbestos in their day-to-day work with asbestos materials or because work with asbestos was carried out near them).
4 Asbestos exposure incidents understandably cause anxiety about the possible effects, both short- and long-term, of the exposure. In many cases exposure will have been low, with little likelihood of any long-term side effects. Unfortunately, although the type of asbestos involved may be known there is often little, if any, reliable information concerning the amount of asbestos which may have been inhaled, so it is often difficult to be certain exactly how much long-term risk to health may have been caused.
5 Your employer should try to find out as much as possible about the type of asbestos, the duration of exposure and the likely exposure levels and should keep accurate and detailed records concerning the incident and those people involved. You may wish to request a copy of your record, or to ask your employer to send a copy to your GP.
6 Your employer may arrange for you to have an opportunity to see an occupational health doctor for further advice, or may suggest that you consult your GP. Your GP should be given details about the possible exposure including date(s), duration, type of asbestos and likely exposure levels (if known) and you should ask for a note of these details to be made in your personal medical record. Your GP will decide whether you should be referred to a chest specialist (although this is not usually necessary) or whether you should undergo any tests such as a chest X-ray. Again this is not usually necessary or helpful, particularly because in the short-term a chest X-ray would not show anything wrong, even after heavy exposure to asbestos. In particular a chest X-ray cannot show whether or not asbestos fibres have been inhaled.
7 Your employer should also consider carefully what went wrong to cause you to be exposed to asbestos on this occasion, and how this can be prevented from happening again.
8 For those working in building maintenance, repair and refurbishment HSE publish an information leaflet:
(1) Working with asbestos in buildings (INDG289);
and a pocket card:
(2) Asbestos alert: workers' card for building maintenance, repair and refurbishment workers (INDG188P).
These are designed to help make workers aware of asbestos hazards in building work and to help them avoid accidental asbestos exposure. Single copies of these are available free of charge from:
HSE Books,
PO Box 1999,
Sudbury,
Suffolk,
CO10 6FS
Tel: 01787 881165 or Fax: 01787 313995.
November 2000
| Health and Safety Executive | Information Document |
|---|---|
| HSE 265/48 (Part 3) |
1 This document contains advice following inadvertent exposure or possible inadvertent exposure to asbestos. People who may have been exposed to asbestos are understandably anxious and concerned about possible effects on their health.
2 Inhalation of asbestos fibres can eventually lead to a number of diseases, including:
(1) asbestosis (an asbestos-induced fibrosis of lung tissue),
(2) bronchial carcinoma; and
(3) mesothelioma, a rare malignant neoplasm of the pleura or peritoneum.
It is possible that repeated low-level exposures may lead to asbestos-related diseases, although most cases, particularly of asbestosis and bronchial carcinoma, are linked to high exposure for long periods. There is usually a long delay between first exposure to asbestos and the first symptoms of disease; this can vary between 15 and 60 years, with mesothelioma having a particularly long latency.
2 It is unfortunately not uncommon for people to be inadvertently exposed to asbestos fibres, usually in small quantities, during building operations, maintenance work or following damage to asbestos-containing materials. (Many of those suffering today from asbestos-related diseases worked in the building trades and were exposed to asbestos in their day-to-day work with asbestos materials or because work with asbestos was carried out near them.)
3 Such incidents understandably cause anxiety about the possible effects, both short and long term, of the exposure. In many circumstances exposure will have been minimal, with little likelihood of any long-term side effects. Unfortunately, although the type of asbestos involved may be known there is often little, if any, reliable information concerning the amount of asbestos which may have been inhaled.
4 Workers subject to such exposures may consult their GP for advice, and may have unrealistic expectations regarding medical investigations or even treatment. There is at present no effective post-exposure prophylaxis for the effects of inhaled asbestos fibres, although in smokers the risk of asbestos-induced bronchial carcinoma (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.
5 Asbestos-induced radiological changes have a latency almost as long as that for symptom development (ie many years) and therefore a chest X-ray in the early aftermath of even heavy exposure is most unlikely to serve any useful purpose other than acting as a baseline. Similarly, periodic chest X-rays following an inadvertent exposure episode will serve little if any useful purpose in most cases, not least because in the vast majority of cases asbestos-induced disease is irreversible and untreatable by the time it can be diagnosed. However, a holistic view should be taken; clinical judgement may be that in some circumstances a chest X-ray may be of value where there is severe anxiety following asbestos exposure, and that the benefits of this may outweigh the very low level of risk associated with diagnostic X-ray exposures. In such circumstances the benefits and limitations of undertaking a chest X-ray should be explained carefully to the subject.
6 Further advice on cases of this nature can be obtained from chest physicians with an interest in occupational lung diseases and from medical inspectors of HSE's Employment Medical Advisory Service, who can be contacted at HSE's divisional offices (listed in the telephone directory).
November 2000