Learning to live with the hidden killer

Asbestos is the single greatest cause of work-related deaths in the UK, causing 4,000 deaths per year. The Health and Safety Executive (HSE) reported last year that 2,156 people died from mesothelioma – an asbestos-related cancer that can take 40 years to develop – in 2007, and Britain now has the world’s highest mesothelioma death rate. Although its use is now banned, asbestos is still present in many buildings, including many of our healthcare institutions.
    
“Asbestos is likely to be widespread in older buildings,” says Nigel Bryson, director of Bryson Consulting. “It’s difficult to identify any reliable estimates as to how much remains in buildings in current use, but generally speaking, as all forms of asbestos were banned in 1999, the HSE indicates that any building built in 2000 or after won’t contain asbestos.”

A lethal legacy
You only have to look at last year’s press to see the legacy of asbestos among healthcare professionals. There’s the death of retired hospital maintenance worker John Swales, reported in the Lancashire Telegraph in April. John had worked in several hospitals during the 1960s and had sometimes come home covered in asbestos dust. A post-mortem examination found a staggering eight million asbestos fibre particles in his lungs.
    
Writing in The Guardian last April, just a couple of months before he died, Doctor James Partridge said he believed his mesothelioma was caused by exposure to asbestos-lagged pipes when he was a trainee in the 1950s.
    
Then there’s the Nursing Times report about the rising number of nurses now dying from mesothelioma, after being exposed to asbestos early in their careers.
    
The stories just keep coming, and each one underlines the fact that asbestos has been widely used in buildings such as hospitals and clinics. As Dr Partridge wrote, nobody knew about the harmful effects of exposure to asbestos in the 1950s and 1960s, and many people who’ve worked in the healthcare industry are now suffering from the results of exposure to asbestos decades ago.
    
For all the tragedies now being lived out, at least we now know about asbestos risk. Breathing in asbestos fibres can cause potentially fatal conditions such as asbestosis, lung cancer and mesothelioma. These diseases tend to be significantly advanced by the time they’re diagnosed and in the case of mesothelioma, may leave patients with only a few months to live.

We can’t, however, just get rid of all the asbestos in our hospitals and other public buildings. If we don’t want asbestos to kill people, we have to learn how to live with it – that is, to manage it so it doesn’t pose a risk to people’s health.

A legal duty
The Control of Asbestos at Work Regulations 2006 brings together the previous requirements on asbestos use and bans the importation, supply and use of all forms of asbestos. Crocidolite (blue asbestos) and amosite (brown asbestos) have been banned since 1985, while chrysotile (white asbestos) has been banned since 1999. There’s also a ban on the second-hand use of asbestos products, such as asbestos cement sheets and tiles. But there’s still a lot of asbestos in existing buildings, and for non-domestic premises such as health care facilities, the Asbestos Regulations specify a ‘duty to manage asbestos’.
    
It’s difficult to evaluate how well healthcare businesses are managing asbestos. However, Bryson points out that the HSE health and safety plan for the health sector includes actions like ‘ensuring consistency in dealing with asbestos duty to manage issues’ and ‘proactively seeking examples of poor asbestos surveying work with a view to bringing those that manifestly fail in their duties to account’. This suggests that there may be a need for more consistency in asbestos management across the healthcare sector.
    
“The issues facing healthcare institutions are likely to be identifying if they have asbestos in the building; the quality of the management plan; maintaining an effective asbestos register; and training workers to understand what they need to know about asbestos,” says Bryson. “For example, in GP surgeries housed in old buildings, they might not realise that asbestos could be an issue and what plans are needed.”
    
So, how can you make sure you know about all the asbestos in your buildings – and once you know about it, how should you manage it?
    
In order to manage asbestos effectively, it’s important to understand it. In the past, blue, brown and white asbestos have all been used extensively in building, including insulation, ceiling tiles, fire-proofing materials, guttering and wall panels. While blue and brown asbestos have been acknowledged as the most hazardous types, white asbestos is potentially harmful in its own right, and it’s often mixed with other types.
    
All types of asbestos pose a serious threat. At IOSH, we believe that all asbestos, whatever its colour, needs to be managed with the same amount of care, and that everyone should be protected from inhaling any asbestos fibres.

What you can do
“Duty holders in all buildings should have a plan for managing asbestos, including emergencies where asbestos contamination may occur,” says Bryson.
    
Even if your building was constructed after 2000, you should make sure you know about the site it’s on. If it’s a ‘brownfield’ site which has previously been developed, buried asbestos could still be present.
    
Many healthcare facilities are based in buildings that are more than 10 years old. Smaller concerns such as doctors’ surgeries or care homes might occupy leased buildings, and as with any institution as large as a hospital, many new buildings are simply additions or extensions to an older site. In these cases, there are few certainties in terms of asbestos content, and you should presume that it might be present in any structure built before 2000.
    
The next step is to find out any existing information you can about asbestos in the building. There may be records of previous asbestos surveys, and it’s a good idea to get copies of any plans or reports relating to the building. Even if these don’t contain any information about asbestos use, they’ll be useful for recording anything you find out.
    
You should also look for any records of asbestos work carried out in the past – you might get this information from previous owners, equipment suppliers or companies that have carried out building or maintenance work. This isn’t a failsafe though – in the past, when the dangers of asbestos exposure were less well know, people might not have kept rigorous records of asbestos work. If you don’t find any evidence of asbestos from these sources, that doesn’t mean it’s not there.
    
“The only way of confirming if asbestos is present is to sample materials that may be of concern,” says Bryson. “Legislation allows duty holders to ‘presume’ asbestos if present if materials are suspected. Asbestos may be marked in the original plans of the building. For system-built properties, if asbestos is found in one building, it’s likely to be in the others of that type. The best way to check is to have a survey done.”

Asbestos surveys
An asbestos survey has three main purposes:

• To find asbestos containing materials (ACMs – materials either known or presumed to contain asbestos) and make a record of what, where and how much is there
• To record how accessible the ACMs are, what condition they’re in, and any surface treatment
• To record what type of asbestos is contained in the materials.

There are two main types of asbestos survey – the management survey and the refurbishment and demolition survey.
    
As its name suggests, a management survey provides information for the ongoing management of premises that may contain ACMs. It involves sampling and assessing materials that release fibres if disturbed. It’s important to allow as full a survey as possible – the Methods for the Determination of Hazardous Substances series (MDHS 100), which provides guidance for asbestos surveyors, warns that putting restrictions on the survey – either by the client or surveyor – can seriously undermine the management of asbestos in buildings.
    
A refurbishment and demolition survey aims to locate and describe all ACMs in the part of the building being refurbished – or the whole building if being demolished – so they can all be removed before the work begins.
    
You might think that, when it comes to managing asbestos, you only need to consider the management survey. But think again – in a large organisation such as a hospital, refurbishment, demolition and rebuilding of different parts of the site might be fairly frequent occurrences. While the management survey is crucial, you might need to consider both types of survey as part of your asbestos management system.
    
It’s also important to make sure your surveyor is competent to do the job. The HSE advises that you use surveyors accredited to BS EN ISO 17020 by the United Kingdom Accreditation Service, or those certificated by the Asbestos Building Inspectors Certification Scheme.

So you’ve got it – what now?
Once you’ve confirmed the presence of asbestos, you need to manage it to keep staff, contractors and visitors safe.
    
If ACMs are in good condition and are not likely to be damaged, worked on or disturbed, then it’s safest to leave them in place. Your asbestos management system should then aim to make sure the right measures are taken by maintenance workers and outside contractors whenever work is done that could disturb asbestos-related materials.
    
“As long as asbestos materials are in good condition and sealed, fibres can’t be released,” says Bryson. “When asbestos materials are removed or worked on, proper control measures should minimise fibre release. But if work is shoddy and areas contaminated, people may be exposed.”
    
Any work that might disturb the fabric of the building should be assessed to make sure ACMs won’t be affected. The duty holder should also inform anyone working in the premises that they must not disturb the fabric of the building without permission, and tell maintenance teams and outside contractors where ACMs are located. In addition, warning signs or labels should be displayed on ACMs.
    
You also need to provide training courses for members of the property management group, maintenance supervisors and staff so they know about the potential hazards associated with exposure to asbestos, the location of any ACMs, how to handle and dispose of them safely, and how to maintain records. IOSH provides safety awareness training for managers and employees, as well as professional courses for health and safety practitioners, facilities managers and anyone who manages risk programmes involving asbestos.
    
Once you’ve put your safety measures in place, you need to assess all your ACMs on a regular basis to make sure they’re still safe. How often you do this will depend on factors like the condition of the materials, how accessible they are and the level of activity in the area.
    
Corrective measures
You might find that you need to take corrective measures such as minor repairs, enclosure or encapsulation of ACMs. Apart from minor works with a very low risk of exposure, any asbestos work must be done by companies licensed by the HSE. It’s important that any work that might disturb ACMs is compliant with the Control of Asbestos Regulations 2006, so the job doesn’t expose those doing the work, or anyone else, to risk from the asbestos.
    
The slow development and late diagnosis of many asbestos-related diseases means that we’ve not yet seen the worst of its effects on those exposed decades ago. We may know more about asbestos risk now, but this is no time to become complacent. Only by learning to live with asbestos – by constantly monitoring and managing it – can we make sure that today’s healthcare staff and contractors don’t become the asbestos victims of tomorrow.

About IOSH
IOSH is the Chartered body for health and safety professionals. With more than 36,000 members in 85 countries, we’re the world’s biggest professional health and safety organisation.

We set standards, and support, develop and connect our members with resources, guidance, events and training. We’re the voice of the profession, and campaign on issues that affect millions of working people.
IOSH was founded in 1945 and is a registered charity with international NGO status.

For more information
IOSH: www.iosh.co.uk
HSE: www.hse.gov.uk/asbestos
Control of Asbestos at Work Regulations 2006: www.hse.gov.uk/asbestos/regulations.htm
United Kingdom Accreditation Service: www.ukas.com
Asbestos Building Inspectors Certification Scheme: www.abics.org