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CONCERNS FOR THE HEALTH AND SAFETY OF WELDERS IN 2005

CONCERNS FOR THE HEALTH AND SAFETY OF WELDERS IN 2005

G. McMillan1 (United Kingdom) E-mail: GHGM@doctors.org.uk

ABSTRACT
The author presents a brief review of some of the health and safety topics he believes merit priority attention by the welding industry. These comprise avoiding wear, tear and health wastage; poor standardisation of risk assessment of fume exposure; manganese, manganism, Idiopathic Parkinsons Disease and welding; susceptibility to pneumonia; eye malignancy; excess risk of lung cancer in welders; and preventing a new epidemic of old occupational diseases in industrialising countries.

IIW-Thesaurus keywords: Welding; Health and safety; Fume; Occupational health; Toxic materials; Manganese; Occupational diseases; Reference lists.

1 INTRODUCTION
Many in the welding industry are keen that it loses its dirty and dangerous label as this is a disincentive to those who might otherwise fill the many vacancies for trainees and skilled welders and may also make it an unattractive choice in the eyes of influential parents and partners. It is, however, a sad truth that, while in many workplaces welding may be cleaner and safer than in the past, there remain well-founded concerns for the health and safety of welders. These range widely from the daily grind of minor scrapes, burns and wear and tear injuries to the musculoskeletal system, through lung cancer and asbestos-related diseases to the more recently raised concerns over the possible increased risk of certain degenerative disorders of the nervous system, pneumonia and other inflammations and a rare and usually fatal eye disease being occupational diseases of welders. The concerns need to be more thoroughly explored and the risks of harm assessed and controlled and shown to be controlled adequately if welding is to be seen as a safer and cleaner occupation in the industrialised and industrialising world. In this paper I review briefly those

threats which currently concern me most and which I believe should concern everyone in the welding industry those conceiving, financing and designing fabrications; all who contribute to the work being done through providing equipment, consumables, knowledge and management; and the welders who complete the task. All have their part to play in improving the health and safety of welders and those who work with them and, as skilled people are the most valuable business asset, thus contributing to the long term wellbeing of the industry. Topics I believe merit priority attention in these first years of the twenty first century include: avoiding wear, tear and health wastage; poor standardisation of risk assessment of fume exposure; manganese, manganism, Idiopathic Parkinsons disease and welding; welders apparent susceptibility to pneumonia; possible excess risk of eye malignancy in welders? excess risk of lung cancer in welders; preventing a new epidemic of old occupational diseases in industrialising countries.

Doc. IIW-1719-05 (ex-doc. VIII-1993-05) recommended for publication by Commission VIII Health and Safety.
Welding in the World, Vol. 50, n 3/4, 2006

Dr. Grant McMillan, an occupational physician in independent practice, is an Honorary Senior Lecturer in Occupational Health at the University of Birmingham, UK. He is Chairman of IIW Commission VIII (Health and Safety).

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2 AVOIDING WEAR, TEAR AND HEALTH WASTAGE

At some time in their working life almost all welders suffer, often repeatedly, painful and otherwise unpleasant injuries such as burns to the skin, grinding dust or a chipping of slag in the eye or arc eye caused by overexposure to ultraviolet radiation. Many are progressively disabled, for example, by noise-induced hearing loss (perhaps the most common work injury of welders) and the stresses and strains on the musculoskeletal system of achieving difficult access and egress to the workplace for the day, perhaps deep in a ship or within a narrow entrance pressure vessel, holding joint-wrenching work positions whilst welding overhead, twisting their backs to reach inaccessible weld sites or lifting heavy work pieces. Research suggests that musculoskeletal disorders are the most common health reason for leaving work as a welder. At the extreme end of the scale, few years pass without reports of welders dying from fire, electrocution or asphyxia. This human suffering and wastage is expensive in reduced productivity and thus costs and is largely preventable. I doubt that an equivalent level of material waste would be tolerated. Everyone in the welding and fabrication industry, and I do mean everyone, has an important part to play. Considering but a few, I start with designers and ask that they consider more thoroughly the health and safety of workers who are to fabricate and maintain their projects. How can access be made easier? Can ventilation be achieved easily? Can above-shoulder and overhead welding be reduced or eliminated? Engineers and managers should follow the same thought process, ensuring that work procedures are designed with the health and safety of the worker in mind and using ergonomic design and procedures to maximum advantage to, for example, lift and position work pieces and support the welding gun. There are a number of ISO standards to help in this regard [1]. They should supervise and strictly to control risks as far as is practicable. Many other key intermediaries have a part to play before attention focuses on the welders themselves. The importance of their role can hardly be overstated. Many do much more now in the way of health and safety than in the past but there is still a way to go. Every welder should take more responsibility for their own protection.

Education and training are probably the most cost-effective means of improving health and safety but it should not be bolt on separate lessons but rather an integral part of instruction, a golden thread running through every lesson of every course.

3 POOR STANDARDISATION OF RISK ASSESSMENT OF FUME EXPOSURE

High quality risk assessment is one of the keys to success in protecting the health and safety of welders. Without it there is the risk that adverse effects will be mistakenly attributed to welding, too little will be done to control hazards which really do cause harm or, conversely, costly control measures might be introduced without due cause. It would be sensible to have global standardisation of sampling and analysis methods and of occupational exposure limits to offer the same level of protection to all workers and it concerns me that this is not yet the case. It also concerns me that there are so many barriers to standardisation and such variation between countries in the occupational exposure limits which are set on the basis of the same evidence. Steps are being taken to achieve greater standardisation but it is too little, too slowly and the results are being embraced by too few. The variation is exemplified in the figures of Table 1, which I have adapted from IIW Doc. VIII-1996-05 [2] where the topic is considered in greater detail. At least all the current control limits shown are expressed in mg/m3. The barriers to success, which must be overcome as a matter of urgency to allow improvements to be achieved globally include:

3.1 Site of sampling

From the number of samples taken with sampling heads attached to welders lapels one might think that they breathe through an aperture somewhere under their chin! It may be that samples taken there, rather than within the true breathing zone (adjacent to nose and mouth), are or can be made representative of the actual exposure the welder gets behind his mask and when the mask is up between weld runs, but there has not been adequate research to allow that assumption to be made. Without this work, and standardisation of meaningful sampling, setting standards and monitoring exposures cannot be thought reliable.

Table 1
Country Netherlands Sweden UK USA Limit title MAC OEL WEL PEL Total fume 3.5 5.0 CrVI 0.025 0.02 0.05 CrIII 0.5 0.5 0.5 0.5 Insol Ni 1.0 0.1 0.5 1 Mn 0.2 0.2 0.5

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3.2 Substances and particle size

There is variation between countries as to which substances, if any, should be sought separately in analysis and whether the sample and the standard should be based on total, inhalable or respirable particles. Currently, experts are working within the ISO/CEN framework to prepare an updated standard on guidance for sampling of gases and inhalable, thoracic and respirable fractions of airborne particles in the breathing zone of welding and allied process operators [3]. This will be EN ISO 10882-1 and 2. This should remove one important barrier. I hope all countries will adopt it for general use within the industry.

centration depending to some significant extent on the concentration of manganese and its compounds in the consumables being used. Such compounds are also found in the fume arising from processes allied to welding. These include hardfacing, used to impart added hardness, for example to the biting edges of digging machines and to rail tracks where they cross as frogs, and arc cutting or gouging of metal which may be used to cut bars of ferromanganese in foundries. Manganese is essential to the health of humans. It is needed only in trace amounts. Absorption and excretion are usually managed automatically by the body to achieve the necessary balance. These homeostatic mechanisms can, however, be overwhelmed when too much manganese is taken into the respiratory system and absorbed through the lungs. This can occur with prolonged excess occupational exposure to bio-available manganese compounds. It has been asserted in the scientific literature, and fiercely debated in occupational health circles and in the courts, that exposure to manganese compounds in welding fume may cause disorders called clinical manganism and sub-clinical manganism and bring about the unusually early onset of Idiopathic Parkinsons Disease. There is substantial evidence in the literature that some welders to be exposed in their working life to high concentrations of manganese-containing fumes for at least short periods and often for longer so that the extant occupational exposure limit was exceeded. This evidence may, of course, be unrepresentative of the industry. The overall evidence of exposure gathered from the literature, flawed as much of it is, indicates that much lower exposures were a more common experience. Exposure need not lead to absorption should the manganese be present in a form which is not bio-available. Some investigations are said to show that manganese compounds are sealed within particles of welding fume and, in consequence, are not dissolved in biological fluids in the lungs so only a very small proportion of the dose which enters the lungs passes into the circulation. Conversely, other investigations are said to indicate that the manganese-containing particles in welding fume can be ingested by macrophage scavenger cells in lung fluid then disappear from them presumably having been dissolved and the constituents absorbed. This is a matter of great contention which is unlikely to be resolved until experiments are concluded successfully to expose animals to welding fume and determine, convincingly, its course and sites of deposition in the body perhaps by specifically labeling it with a radio-active marker. This has yet to be done. It will need considerable skill, funding and endeavour.

3.3 Helmet design

Many modern helmets appear to be so close fitting that there may not be room for the traditional boom mounted sampler to be accommodated. If there is a need to sample within the helmet, and until proven otherwise I believe there is, then in these days of international standardisation it seems ridiculous that helmets which do not permit sampling can be marketed.

3.4 Analytical methods

Significant differences can be created by using different techniques to analyse the particles sampled yet there is no global standardisation of methods. Work to standardise the methodology for generating fume composition data prescribed in EN ISO 15011-4, now nearing completion and reported recently [4], may provide a model for achieving standardisation of analysis of fume samples but only if the outcome is accepted and applied by all countries, or at least those where major producers and users of welding consumables operate and market. The use of different methods and units to express exposures hinders easy comparisons. While this can be overcome by conversion calculations it adds to difficulties and costs. Different bodies of experts interpret the same evidence in different ways [2]. Surely scientific debate on an international scale can achieve agreement on what research findings mean in terms of risks to health and their control. Sadly, while this might be achievable, legalistic, economic and political reasoning would be likely to create variation where there had been scientific agreement.

4 MANGANESE, MANGANISM, IDIOPATHIC PARKINSONS DISEASE AND WELDING

Manganese is an essential component of steel and thus of the consumables used to join steel components by electric arc welding. Manganese compounds are present in the fume from such welding processes, their con-

4.1 Clinical manganism

Cases and other studies described in the scientific literature show that excessive absorption and retention of manganese absorbed by humans in occupational and environmental situations other than exposure to welding fume may damage specific cells in the deep-lying part of the brain called the basal ganglia.

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The function of these cells is to receive and be activated by the chemical neurotransmitter dopamine. Damage to the cells by manganese is permanent and progressive. It is widely agreed that this may produce the disease of clinical manganism. This is characterised by specific clinical manifestations, including psychiatric upsets and poor control of movements. These may develop, persist or even increase after exposure to manganese has ceased. The diagnosis may be confirmed by modern imaging techniques which demonstrate the integrity of the dopamine functional chain up to but not into the damaged receptor cells. There is good evidence that some workers in occupations other than welding develop clinical manganism after less exposure than most workers in that occupation require before they develop clinical manifestations of manganism. This susceptibility may be geneticallydetermined. Over the years cases have been described in workers in manganese mines; ore crushing, sorting and grinding mills; the production of manganese salts and oxides; dry battery production; manufacture of enamels; pottery and ceramics; smelting and ferromanganese foundries and other steel works; manufacture of welding electrodes; and metal cutting and welding. It is important that papers such as this are not only free from bias but also that the reader can form a view on any risk of bias. In the latter regard I wish it to be known that in 2004 attorneys representing defendants in cases before the US courts alleging harm induced by exposure to welding fumes engaged me to conduct an independent systematic review of the scientific literature relating to manganese, manganism and Parkinsons Disease and draw conclusions. It was a condition of my accepting that task that I would be absolutely free to report my findings and conclusions in the open literature without consultation. That initial review work is now complete and I have drawn upon it here, albeit only to report the main conclusions on the incidence of manganism in welders. A much more detailed report and fully referenced report is being prepared for publication. In that review of the literature from before commercial welding started in about 1917 up to 2005 I identified only some 39 asserted cases of clinical manganism in workers classified as welders. I suggest that this low incidence statistic alone argues loudly against the assertion that welders are or have been at high risk of developing clinical manganism from exposures at work. Moreover, my detailed examination of the published surveys and case reports related to men classed as welders has revealed to me that most of these men were not actually employed to weld, that is to join metal, but instead were hardfacing or cutting metal using arc processes. Next I assessed the admittedly often sparse clinical descriptions of the other cases, those where men may have been welding, against the cardinal diagnostic features of clinical manganism. I could not categorise any one as a case of clinical manganism with any degree of confidence.

From this part of my review I have concluded that the risk of clinical manganism as a consequence of welding and allied processes has been low and, judging by the lack of evidence presented, possibly does not even feature as an adverse health effect in men welding as a joining process.

4.2 Sub-clinical manganism and welding

It has been asserted in the literature that sub-clinical damaging effects of exposure to lower concentrations of manganese may be detected by reduced performance in neurobehavioural and psychometric tests. The studies are of mixed quality and some are significantly flawed. Of the twenty one I reviewed I classed only nine to be of good to moderate methodological quality for the purpose. Only one of these was about welders and the results were not persuasive of a hazard associated with welding. Overall the evidence of a link between reduced performance and exposure to manganese compounds in any of the several occupational situations described is neither consistent not convincing. No consistent link to clinical manganism, no dose-effects relationship and no putative site of damage has been established. Other investigators have since reached similar conclusions.

4.3 Idiopathic Parkinsons Disease

It has been suggested, principally by one set of investigators, that Idiopathic Parkinsons Disease may occur earlier in the life of welders than it does in the general population, perhaps because of their exposure to welding fume and to manganese within it. Other studies do not offer supporting evidence. Idiopathic Parkinsons Disease is a common progressive neurodegenerative motor disorder characterised by a well defined set of signs and symptoms. It usually affects those over 50 years of age. By the age of 65 years about 1 % of the population is affected. The manifestations of the disease are caused by destruction of the cells in the brain which produce the neurotransmitter dopamine. It will be recalled from remarks earlier in this paper that clinical manganism is caused by destruction of cells with the function of receiving and being activated by dopamine. While there is some dissent, it is widely agreed in the literature that clinical manganism and Idiopathic Parkinsons Disease are two distinct diseases which are clearly distinguishable one from the other by symptoms, signs and special tests including imaging of the brain. There is, however, nothing to prevent them co-existing but the chances are small given the rarity of manganism. As the word idiopathic discloses, the cause of Idiopathic Parkinsons Disease is unknown. It is important to note that it has not been asserted that exposure to welding fume or manganese causes Parkinsons Disease but rather that it might make it come on earlier. Although the evidence is not convincing, this assertion has caused much excitement in the field of litigation.

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It would be a gross understatement to suggest that there are not several unresolved key matters of contention. These include: are compounds of manganese in welding fume bioavailable? what degree of protection against absorption and transport of bio-available manganese compounds is afforded by the presence of high concentrations of iron and perhaps other materials? are the manganese compounds able to cross the blood-brain barrier and destroy dopamine receptor cells? what do studies of large groups of welders tell us about the age those affected with Parkinsons Disease develop it compared to other working men. Until these matters are settled by appropriate investigation uncertainty will continue to generate concern in the welding and fabrication industry and anxiety in welders who might think themselves affected. There is an urgent need for meticulously-conducted studies of absorption and retention of manganese from welding fumes and for a large-scale case-control study to investigate the hypothesis of early onset of Parkinsons Disease.

there is an elevated risk of the rare disease of ocular melanoma in welders, increasing with job duration [6]. Diagnosis of ocular melanoma tends to be late in the course of the disease as it is quite literally out of sight. It tends to metastasise before diagnosis, often to the liver, and this makes it a usually fatal disease. The French investigators suggested that exposure to ultraviolet light is the likely causal agent. A more recently published study from Australia has shown that the risk of this type of melanoma increases with increasing duration of welding exposure, although the trend was not significant overall [7]. On the other hand, a large study did not list welding as an occupation linked to melanoma [8] and a recent review found the only major study of the relationship between arc welding and skin cancer did not reveal an increased incidence of that disease [9]. In that study, however, the welders were well protected and the exposure time short. Clearly more careful investigation on a large scale is needed to clarify the situation. In the meantime, welders should ensure that they use their eye protection shields and curtains carefully whenever there is a risk of someone striking an arc.

5 WELDERS APPARENT SUSCEPTIBILITY TO PNEUMONIA

There is longstanding convincing evidence that exposure to high levels of certain constituents of welding fume can induce inflammation which may be manifested in effects such as metal fume fever and chemical pneumonitis. Specific constituents of the fume, notably chromium compounds from stainless steel welding, have been shown to cause occupational asthma, the cause proven by challenge testing, though this appears not to be a common consequence of employment as a welder. Recent research in England using the case-control method has confirmed the suggestion raised by national statistics that welders have an excess risk of dying from pneumonia and offered an explanation in that those who are exposed to metal fumes at work have increased susceptibility to infectious pneumonia [5]. Work continues to explore that finding and determine the mechanisms.

7 THE EXCESS RISK OF LUNG CANCER IN WELDERS

Lung cancer is a common disease. Steps to prevent it are critically important as diagnosis is very often made too late to allow a cure to be effected, though surgery and other therapies may provide relief for some time before the usually fatal outcome. The spotlight has settled on welders because welding fume has been classified as possibly carcinogenic to humans [10] and national statistics and epidemiological studies have shown that this occupation is associated with a 30-40 % higher risk of developing lung cancer than is found in the general population. I believe this evidence to be sufficient for preventive action to be taken. It is, however always best to know the agent or agents responsible for such an excess risk rather than, as it were, stumbling around in the dark firing off rounds indiscriminately. Only when the cause is known can there be confidence that the most effective protective actions are being taken to control the risk. While this has yet to be done with absolute certainty in the case of employment as a welder, the International Institute of Weldings Working Unit on Health and Safety, Commission VIII, agreed in 1992 that sufficient was known about possible causes for much to be done on a general or empirical basis. A consensus statement was published at that time [11]. This was reviewed in 2000 and 2003 and a minimally revised statement was agreed in 2004. This will soon be addressed in IIW document VIII-2004-05 [12]. A full consideration of the topic has been published elsewhere [13]. In the 2004 statement the Commission remarks that the link with occupation suggests that the work environment is likely to play a part and the prime suspects are thought

6 OCULAR MALIGNANCY
Arc welding is one of the most intense artificial occupational sources of optical radiation. Each type of welding emits a different and continually changing spectrum and intensity of optical radiation. For most processes ultraviolet and visible radiation are the main components of the emission. Ultraviolet radiation is causally related to skin and ocular malignancy. Is it possible that welders are at a greater risk of developing these cancers than the general population? Those who conducted a case-control in France, published in 2001, considered that they had established that

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to be welding fumes and gases, tobacco smoke and asbestos dust acting alone or together. Social factors other than occupation but reflecting income may also play a part. The Commissions conclusions are reported here as it is important that they are broadcast as widely as possible so that action may be taken to implement this guidance. The conclusions Commission VIII has drawn to date are that: Electric arc welders have an excess risk of 30-40 % for lung cancer; The work environment is likely to play a part in the causation of that excess; Welding fume from some welding processes contains compounds of elements which are proven carcinogens in other work processes; The evidence for welding fume or its constituents acting as a carcinogen is not strong; Asbestos dust and tobacco smoke are likely to be major contributors to causation; Action is needed to further control recognised risk factors such as smoking, exposure to asbestos and to welding fumes.

although sometimes more expensive in immediate terms, safe working conditions can speed and maintain the establishment of long term prosperity and then help them achieve that situation. The compulsion of legislation may prove to be necessary. It behoves the welding and fabrication industry and those exporting joining tasks to industrialising countries to pursue these challenges to protect rising generations of welders in industrialised and industrialising countries, ensuring that the mistakes of the past become the lessons for the future, and that production savings are not made through increasing the price to be paid in human health and environmental damage. I would hope that IIW might play a significant part in achieving that aim.

9 CONCLUSION
Clearly there are several specific disease concerns for welders. All have serious consequences for health. Some have established direct or indirect causal links with welding while others, such as the possible effects of exposure to manganese, are based on weaker evidence and are veiled in morale-sapping and depressing uncertainty. Illness and injury of welders and those in allied trades may lead to absence, long term disability and enforced premature retirement from welding or even from all forms of work. Such a record must make recruiting more difficult as young people, and their partners and parents, are not attracted to welding as a career because they believe it to be dirty and dangerous. Within the recruited workforce, expensively trained skilled workers may choose to move to other employment they consider less threatening. Employers lose the earning capacity of these workers and have to bear costs of recruitment and training. There is a good business case for the welding industry to clean up its act now and let the world know about the successes it achieves!

8 PREVENTING A NEW EPIDEMIC OF OLD OCCUPATIONAL DISEASES IN INDUSTRIALISING COUNTRIES

Ignorance, indifference and low regard for the worth of working people made occupational diseases a blight on the development of the now established industrialised countries. Painful lessons have been learnt as to the causes and means of prevention of these disorders. It would be unforgivable if these were not applied in industrialising countries to ensure that this history of ill health and injury is not repeated there. There are, however, indications that this may not be the case. Asbestos provides an example of the need for concern. The need to prevent exposure to asbestos is accepted culture in western industrialised countries. As a result the use of the material there has been totally or virtually banned. I anticipated that this would be reflected in a significant reduction in the amount of asbestos being mined in the world and was shocked to find that US government reports indicate a year-on-year rise in global mining of asbestos so that the total weight of asbestos extracted has increased from 1900 to 2280 thousand metric tons between 2000 and 2004. Where is it going? Who is using it? Are the workers adequately protected? Aggressive marketing of chrysotile asbestos in Asia has been reported recently [14]. It has been predicted that if this succeeds then as asbestos-related deaths decrease in developed countries the number will begin to rise in developing countries. Better regulation and enforcement built on common international standards would be a help to counter such risks of exporting well-documented occupational diseases along with industrialisation. The challenges are first to help new enterprises recognise and accept that,

REFERENCES
[1] Kadefors R.: Ergonomic standardisation and welding, IIW Doc. VIII-1995-05 (in preparation). [2] Jordan D.: Variations in occupational exposure limits, IIW Doc. VIII-1996-05. [3] Engstrom B.: Sampling of airborne particles and gases in the operators breathing zone on welding. Proceedings of FORCE Technology International Conference on Health and Safety in welding and allied processes. 9-11 May 2005. Copenhagen, http://www0.force.dk/hswap/papers.asp [4] Howe A.M., Carter G.: EN ISO 15011-Round robin examination of fume emission rates from welding consumables, Proceedings of FORCE Technology International Conference on Health and Safety in welding and allied processes, 9-11 May 2005, Copenhagen, http://www0. force.dk/hswap/papers.asp.

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[5] Palmer K.T., Poole J., Ayres L.G., Mann J., Burge P.S., Coggon D.: Exposure to metal fume and infectious pneumonia, Am. J. Epidemiol., 2003 Feb 1, 157 (3), 227-33. [6] Guenel P., et al.: Occupational risk factors, ultraviolet radiation, and ocular melanoma: a case-control study in France, Cancer Causes and Control, 2001, 12, 451-9. [7] Vajdic C.M., Kricker A., Giblin M., McKenzie J., Aitken J.F., Giles G.G., et al.: Artificial ultraviolet radiation and ocular melanoma in Australia. Int. J. Cancer, 2004, 112, 5, pp. 896-900. [8] Fritschi L., Siemiatycki J.: Melanoma and occupation: results of a case-control study, Occup. Environ. Med., 1996, 53, 168-73. [9] Dixon A.J., Dixon B.F.: Ultraviolet radiation from welding and possible risk of skin and ocular malignancy, Med. J. Austr., 2004, 181, 3, 155-7.

[10] International Agency for Research on Cancer, Chromium, nickel and welding, IARC Monograph on the Evaluation of Carcinogenic Risks to Humans, 1990, Report No 49. [11] Zschiesche W.: Cancer risk in arc welding, IIW Doc. VIII-1654-92, Welding in the World, 1993, Vol. 33, No. 2. [12] McMillan G.: Background to Commission VIII consensus statement on the excess risk of lung cancer in welders, IIW Doc. VIII-2004-05. [13] McMillan G.: Lung cancer and electric arc welding, The Chromium File Issue 12 Mar 2005, International Chromium Development Association, www.Chromiumasoc.com/publications/crfile12Mar05.htm. [14] Joshi T.K., Gupta R.K.: Asbestos in developing countries; magnitude of risk and its practical implications, Int. J. Occup. Med. Environ. Health, 2004, 17, 1, pp. 179-185.