Health and Safety Issues Relating to Use of Cement

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Health and Safety Issues Relating to Use of Cement Cement “Burns”

Branko R Babic53A Middle WaySummertownOXFORD OX2 7LEUK Tel/Fax: +44 (0)1865 310772E-mail: babic.branko@virgin.netVisit our www:http://homepage.virgin.net/babic.branko/

Abstract.

Health and safety issues at work continue to achieve a low level of prominence in manysectors of the construction industry and in the UK, every year, there are serious cases of injury by cement. It is estimated that 25% of all work related skin problems worldwideare linked to Portland cement contamination. This paper examines the anatomy and biochemistry of skin and proposes a detailed chemical mechanism by which wet cementinteracts with skin layers to cause injury.Only at high pH, does the cement slurry react with the superficial keratin layer of skin todenature, the highly complex, coiled keratin protein structure. The damage process is progressive and time dependant, in effect liquefying the proteins of the protectivestratum corneum to expose the reproductive cell layers to the supersaturated constituentsof cement slurries. Cation concentrations are thought to damage repair mechanisms inthe reproductive cell layers which replenish and maintain skin integrity. Healing takes along time, preventing the injured person from returning to work for many months.Prolonged exposure to cement slurries is thought to affect sensory nerves innervatingskin so that several hours can pass before awareness of injury become obvious.Cement burns are easily avoided by observing good practice and current advice by professional bodies with a summary of the damage process is provided, for display onnotice boards.

Introduction

Damaging effects of cement in contact with skin were reported as early as 1700Ramazzini

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and were attributed to contact dermatitis as late as 1960

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. Subsequent1

analyses of an actual example of a cement burn case, led to the classification of suchtissue damage to be specified as a reaction to cement in 1963

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and further consolidatedin the 1970s

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, 1980s

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and 1990s

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. Surprisingly little attention has been devotedto this subject, given that the damaging effects of wet mortar on skin, must have beenknown about since Roman times (lime kilns)

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. As late as 1988, the UK constructionindustry and the Health and Safety organisations, specified the condition as a “ConcreteBurn”

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.Since then, it has successfully been argued that as cement was the causative agent of such injury, that the condition should be referred to as a “Cement Burn”

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and not“Concrete Burn”. All cement products cause damage to skin and literature currently published, refers to the damaging process as a “Cement Burn”.The cement bonded fiber composite industry, construction industry

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cementmanufacturing, cement blending facilities and others

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continue to report a steadystream of cement burn events. The hospitalised accidents tend to be severe, debilitatingand even life threatening, forcing industrial compensation tribunals and the courts toaward hefty damages in favor of the injured party. Most countries in the world usemillions of tons of cement each year and yet, the number of cement burns reportedremains relatively small

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. Little information is available to demonstrate the detailedmechanism by which cement damages skin and in an effort to provide understanding, theenclosed paper proposes a step-by-step mechanism by which skin components aredissolved by the highly alkaline cement solution.Cement damage to skin starts when the cement slurry interacts with the oily coatingcovering the superficial layers of skin. The caustic reaction of calcium hydroxide at high pH, strips the skin of its protective oily coating to expose the keratinised layer of the skinepidermis. This layer of dead skin cell debris, is mostly keratin and it is the arrangementof this protein and its various levels of structural complexity that need to be unraveled,in order to understand how the cement solutions causes damage to skin.In all cases of cement burns, the clear fact that emerges is that damage is seen only after relatively prolonged exposure to the highly alkaline solution and that only cementslurries cause damage to skin. Cement powder in contact with dry skin does not causecement lesions. From examples of injured workmen, it can be seen that in areas of the body where the epidermis is thick, such as the skin above the kneecap

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, or the solesof feet, no damage is observed but in areas where thinner less calloused skin comes intocontact with the slurry, severe damaged can result. This observation is further consolidated by the rapid and severe damage done to the non-keratinised cell coating of the cornea

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.The thickness of the keratinised epidermis is therefore relevant, to the severity of damage to skin by cement slurries. Examination of damaged skin in workers whohandled wet cement for several hours without protective clothing, demonstrate that provided the stratum corneum remained intact, no lasting injury to skin is seen. Cement burns, only occurs when the protective layer of skin is opened up to allow the causticelements to come into contact with the live, reproductive layers of skin. The woundingeffect takes place at the delicate stratum germinativum, the reproductive layer of theskin. Once destroyed the damaged areas are repaired by the formation of scar tissue.2

This paper considers the histology of the epidermis and the composition of the Portlandcement are described in an effort to explain how slurries i.e. solvated cement solutionsdamage skin. This information is then used to make recommendations regarding ways of minimizing the severity of damage to skin in the working environment. The importantfindings of this paper include the length of time of contact with cement and the high pHof the slurry solutions which is needed to cause damage to skin. This paper concludesthat the terminology of cement burns needs to be reclassified since the process thatoccurs is not one of “burning” but rather “chemical solvation”.

Histology of the Epidermis

A step by step analyses of cement burns requires an understanding of the structure of skin and its chemical make-up. In Fig 1 the various layers that make up skin aredemonstrated.Keratinized Surface CellsStratum Corneum Stratum Lucidum Stratum GranulosumStratum SpinosumStratum GerminativumDermis Fig 1 The obvious structure in this cross section of thick skin is the superficial dead cell layer called the Stratum Corneum (SC). This layer of cells is the protective shield that provides the barrier between the external and the internal environment of the livingtissues that compose the body. The nature and structure of this layer allows the body to perform all the many activities that an individual undertakes and it is this layer that prevents mechanical damage to living tissues, invasion of microbes, loss of fluids andthe many other functions that the SC performs. Lipids are secreted by cells of theepithelium. These glycolipid deposits between the cells form the very importantepidermal permeability barrier that helps to make skin water repellant. During allactivity, the dead layers of the corneum are continuously shed by abrasive forces, to bereplaced by cells from the deeper reproductive layers of the epithelium.The principal protein of the corneum is keratin, so that the mechanism outlined in this paper will relate to keratin chemistry. Keratin is classified as an insoluble structural3