Silicosis and the Importance of Medical Audits

Silicosis and the Importance of Medical Audits

Witten by Dr. Farrell Cahill, PhD, Director of Research, Horizon Occupational Health Solutions

What is silicosis?

Silicosis is caused by improper respiratory protection and is a work-related lung disease that can develop after prolonged inhalation of high levels of silica dust. 

Crystalline silica is one of the major components of soil, rock, sand, granite and many other minerals mined in Canada, and – because its dust is very light – it can remain airborne for a long time and travel far distances.

Silica particles become trapped in air spaces in the lungs, causing inflammation in the lung tissue. 

Nodules (clumps or clusters of cells) and scars (fibrous tissue) then form around the trapped silica particles — and

If the nodules keep growing, it becomes hard to breathe.   While this can take years to happen, and often even longer for the scars to show up on an X-ray, once the damage has been done, it is irreversible.

Many workers who have silicosis initially show no signs of it — and rarely will a worker die from silicosis — but its symptoms can be progressive, chronic, and debilitating at its advanced stages. 

Moreover, exposure to silica in the workplace can be prevented.

Risk Factors

The risk and severity of silicosis depend on a number of factors;

• Level of and duration of dust exposure
• Size of the dust particles (particles must be small enough to reach the lungs for silicosis to develop)
• Lifestyle conditions like smoking, which often accelerates the process  

The symptoms of silicosis include;

• Shortness of breath following physical exertion
• Severe cough
• Feeling excessively tired
• Loss of appetite
• Chest pain
• Fever

Are medical audits necessary?

Silicosis requires consistent monitoring.  Although it is employers’ responsibility to meet their regional Silica Code of Practice, the application of these guidelines will vary greatly from organization to organization.

Since silicosis rarely develops rapidly, employers may not recognize the urgency of implementing and maintaining safety precautions, but improved workplace conditions as a result of screening for silica exposure can sufficiently reduce the development of the disease and others linked to mining.

This kind of program is for anyone working in the mining industry and should include:

• Medical and work history tracking via questionnaires
• Regular physical exams
• Lung function tests
• Chest x-rays

Medical screening programs will usually reveal cases of silicosis in a workplace — whether truly new cases or those that have developed over time and only recently became symptomatic. 

Due to the latency surrounding the expression of silicosis, employers and regulating bodies may be quick to assign fault to their current codes of practice when cases are identified, but this matter is complicated.

It is advantageous for employers to collect sufficient information about the work history and the respiratory health of all employees, as well as to obtain accurate records of the Silica Code of Practice for each of their past work environments. 

Properly interpreting the cause of new cases of silicosis is not often easy, so the need for due diligence by employers and regulating bodies is critical.

The future of mining medical audits

The need for medical screening programs is of growing importance to accurately detect the direct cause(s) of silicosis and what steps can be taken, if necessary, to reduce its occurrence.

To be more effective, regulating bodies must ensure that employers continue to collect each employee’s personal work and health information and safeguard it long after they have retired or changed workplaces. 

This is crucial in order for auditors to properly pinpoint the length of exposure and the time since exposure when examining cases of silicosis. 

Without proper record keeping, medical audits often misinterpret “new” cases of silicosis that may have actually initiated in the past under an earlier code of conduct.

Employers should also digitize employee records so that auditors can effectively sample them. A great deal of time and money is required to obtain and evaluate hard copies, which don’t allow for the most accurate data sampling.

Protect yourself

Employers must do their part in protecting workers from silicosis, but what can employees do to protect themselves?

• Minimize dust by following good work practices, such as removing dust with a water hose or vacuum with a high-efficiency particulate filter
• Wear, maintain, and correctly use approved particulate respirators
• Participate in training, exposure monitoring, and health screening and medical surveillance programs to monitor any adverse health effects caused by crystalline silica exposure
• Wear disposable or washable work clothes and shower after work if facilities are available
• Do not eat, drink, smoke, or apply cosmetics in areas where crystalline silica is present (wash your hands and face outside of dusty areas before performing any of these activities)
• STOP SMOKING