Comments are closed. A look at the needs of workers who operate handheld vibration tools that mayincrease the risk of developing hand-arm vibration syndrome (HAVS), by JennyMason Hand-arm vibration syndrome (HAVS) is a chronic disorder recognised as anoccupational disease, which occurs following sustained exposure to vibratorypower tools. It is often described as resembling Raynauds disease; however, only thevascular component of the condition can be confused in the two conditions. Vibration white finger (VWF) has been prescribed under the IndustrialDiseases (Prescribed Diseases) Regulations since 1985, as reported by the RoyalCollege of Physicians in 1993.1 In 1997, the British High Courts confirmed that vibrating handheld powertools can cause VWF. The success of this test case, initiated by a group of coal miners, led theGovernment to formally recognise liability in January 2000 and confirm that VWFwas an industrial disease. An agreement to pay compensation to more than 30,000former miners suffering from the disease resulted in payouts of approximately£500m.2 The precise number of construction workers exposed to hazardous levels ofvibration in their work remains unclear. However, based on the success of theminers test case, construction industry employers must be aware of thepotentially high litigation costs that could be imposed if attempts are notmade to reduce these risk factors for their employees. Ramazzini stated as far back as 1713 that: “Certain violent andirregular motions and unnatural postures of the body, by reason of which thenatural structure of the vital machine is so impaired that serious diseasesgradually develop there from”.3 While handheld power tools could hardly have been considered a threat in1713, Ramazzini certainly recognised that repeated physical activities could beresponsible for causing ill health among workers of the day. The adverseeffects of exposure to hand-arm vibration have been recognised since 1911 whenLoriga reported “dead fingers” among Italian miners who usedpneumatic drills.4 HAVS is still prevalent today, and the Health and Safety Executive (HSE) hasrecommended health surveillance for all workers in jobs identified as givingrise to significant risk of hand-arm vibration syndrome.5 At present, there is no legislation limiting vibration exposure, but the HSEhas issued guidance to employers in the form of HS(G)88 ‘Vibration’.6 As an occupational disease, it is vitally important that occupational healthadvisers (OHA) are able to recognise the signs and symptoms of the condition.HAVS is a complex condition that can affect the vascular, nervous andmuscular-skeletal systems of the upper limbs – the hands in particular. Vascular damage to one or more of the fingers is characterised by theepisodic blanching of the fingers. The tips are usually the first to demonstrate signs of damage, although thethumbs are not usually affected. Neurological symptoms may include tingling inthe fingers, loss of dexterity and reduced sensitivity to touch andtemperature, and these symptoms occur as a result of damage to the small nerveendings in the skin. Musculoskeletal symptoms can include muscle fatigue and a reduction instrength, although the exact mechanism in the development of these conditionsis still not fully understood.7 Workers employed in cold working areas may experience blanching of thefingers if affected by vibration. As vaso-dilation occurs and the circulationto the fingers is restored, the area flushes dark red, accompanied by pain. In advanced cases, the peripheral circulation becomes sluggish, giving abluish-purple tinge to the skin of the digits, and in very rare, severe cases,trophic skin changes (gangrene) occur in the finger tips.4 The diagnosis and assessment of HAVS requires a detailed medical andoccupational history, including vibration exposure, physical examination andspecial tests to assess the damage to the vascular and sensorineural systems.8 The use of the Stockholm classification in the UK has been recommended bythe HSE and by the Working Party of the Faculty of Occupational Medicine (seebox, right).9 An examination, detailed employment history and assessment of recreationalvibration exposure, will enable the OHA to provide advice and recommendationsto both the employee and employer. To precisely identify those at risk of developing HAVS, the OHA needs tofacilitate a full and detailed risk assessment of employees. A risk assessment of the workplace and of the tools to be used, plus athorough health assessment is necessary. This will allow suitable controlmeasures to be implemented within the organisation. The occupational historyshould serve two functions – to enable the doctor to detect adverse influencesof the patient’s work on their health, and to allow sensible advice to be givenon the effects of the patient’s health on future working ability.10 Staff can be educated at pre-employment induction programmes and/or healthassessments, and the information can be reinforced at regular ‘toolbox talks’given by the OHA or the health and safety officer. These talks enable staff to become fully aware of the need to comply withthe recommendations set, ensuring that the recommended exposure limits tovibration are not exceeded, and that the correct and appropriate personalprotective equipment (PPE) is provided and worn. Because HAVS is a relatively recently recognised occupational disease, manyworkers may have been developing the condition undetected. By inviting employees to undertake health surveillance programmes, the OHAmay recognise the early development of the disease, or those that already havean established condition, and can refer them to an occupational healthphysician. Pre-employment health assessments are an ideal opportunity to assessemployees for potential HAVS. Historically, the construction industry has been reluctant to provide timeor facilities for staff to attend health surveillance programmes. In 1998, theHSE published its Good Health is Good Sense document in an attempt to encourageemployers to view health in the workplace in a more positive light. Injuries and work-related ill health costs the construction industry morethan £3bn a year, equating to £1,500 per employee every year.11 The HSE hopes that management will be encouraged to maintain a healthyworkforce, proving that good health makes good commercial sense. Although no specific legal duties or measures must currently be taken toreduce the risk of HAVS (HSE 1994), there is a need for employers to considerwhat action is required to reduce the potential risk to staff. Derived from the Health and Safety at Work Act 1974, the Management andHealth and Safety at Work Regulations 1999 (Regulation 3, 1, 1a), clearly statethat every employer should make a suitable and sufficient assessment of therisks to the health and safety of its staff to which they are exposed while atwork. VWF is reportable under the Reporting of Injuries, Diseases and DangerousOccurrences Regulations (RIDDOR) 1995. The primary cause of HAVS is work that involves holding vibrating tools orwork pieces. Vibration with a frequency range from 2-1500Hertz (cycles persecond or Hz) is potentially damaging , and is most hazardous in the rangebetween 5-20Hz (HSE 1990). Several factors that will affect the severity of the risk need to be takeninto account. The magnitude and the length of time exposed to vibration must becalculated to recommend a safe exposure limit. Considerations need to be maderegarding the grip of the tools and the force required to operate them. Howmuch of the hand is exposed to the tool will determine how much vibration isabsorbed. Climatic factors are also important; HAVS is generally exacerbated in coldweather and conditions. Certain lifestyle factors, such as smoking, can beaddressed at health assessments, as this can also affect the individual’scirculatory system. Although this article has been focused on HAVS among construction workers,the OHA must be aware that other industries may also be exposing staff todeveloping the condition. These would include staff in agriculture andforestry, and often those in engineering or heavy industry. It is highly possible that the construction industry could find itselfdealing with thousands of claims for hand arm vibration syndrome. Evenconsidering the current climate of knowledge, the benefits of healthsurveillance and changes in working practice, the industry could find that thisproblem may continue for many years to come. HAVS could develop into a ‘legal minefield’ for employers, therefore it isvitally important that those providing occupational health become vigilant onhealth surveillance techniques, provide accurate records and ensure that anyrecommendations made are understood and ideally, implemented. Information relating to HAVS is constantly being published in journals –both medical/occupational health and industry. The OHA needs to be constantlyaware of any research-based evidence on the subject, changing practices andrecent legal cases. For example, the European Council has now adopted adirective on physical agents that cause vibration, (2002/44/EC, see Resources,page 31). The days when the only medical care provided on construction sites wassomeone in a first aid hut putting plasters on cuts, are long gone. Certainly, some of the larger construction companies have been leading theway for some time in promoting an effective, pro-active service that will helpimprove the health of staff while at work, but there is still a long way to go.Jenny Mason RGN, BSc (Hons), Dip (OH) References 1. Royal College of Physicians, Hand Transmitted Vibration: Clinical Effectsand Pathophysiology, Part 1: Report of a working Party, The Royal College of Physiciansof London, 1993 2. Law S, Managing Hand-Arm Vibration Syndrome, Health and Safety Briefing,No 188, pages 4&5, 2000 3. Ramazzini, Bernardino, Diseases of workers, 1713, The classics ofmedicine library, University of Chicago press, Illinois, published 1940,Special edition 1983 4. Pelmear P, The HAVS, Management OHS & E, July 1999, pages 27-30 5. Lawson I, Nevell D, Review of objective tests for the hand-arm vibrationsyndrome, Occupational Medicine, vol 47, No 1, pages 15-20, 1997 6. Health and Safety Executive, Hand-Arm Vibration HS(G) 88, HSE Books HMSO,1994 7. Shelmerdine L, Managing Hand-Arm Vibration Syndrome – A Guide for Nurses,Nursing Standard, Vol 13, 22, pages 45-47, 1999 8. McGeogh K, Welsh C, Results of independent medical interview andexamination in the diagnosis and assessment of hand-arm vibration syndrome,Centre European Journal Public Health Supplement, pages 107&108, 1995 9. Health & Safety Executive, A brief history of Hand-arm vibration,Stockholm scale revised the Taylor-Pelmear scale for assessing both vascularand sensorineural components of VWF, 1987 10. Seaton A, Aguis R, McCloy E and D’Auria D, Practical OccupationalMedicine, 3rd Edition, Arnold, London, 1994 11. Green B, Nursing a Healthy Concern (1995), Contract Journal, 2002, pages18&19 www.hse.gov.uk Bad vibrationsOn 1 Jul 2003 in Musculoskeletal disorders, Personnel Today Previous Article Next Article Related posts:No related photos.