Silicosis; Causes, Prevention and Controls

Saad Abdul Wahab (HSE Specialist, Trainer, Practitioner & HSE Legal Advisor)
Head of HSE & HR (TCCL), HSE Advisor (TPPL)
MSC Applied Chemistry, IDip OSH, IDSE, NEBOSH IGC

Introduction:
According to the International Labor Organization, more than 2.3 million deaths
caused due to workplace accidents (Fatal Occupational Injuries) per year across the
globe. But loss of lives due to all these deadly accidents is less than the loss of lives
caused by Dust Inhalation. Silicosis is a disease that is caused by the chronic
exposure of workers with Silica Dust. Silicosis is the most common occupational lung disease worldwide; it occurs
everywhere, but is especially common in developing countries. From 1991 to 1995, China reported more than 24,000
deaths due to silicosis each year. In the United States, it is estimated that 1.7 million workers have had occupational
exposure to crystalline silica dust and 59,000 of these workers will develop silicosis sometime in the course of their
lives. Currently fatality rate due to Silicosis in US is 250 workers per year and disability (not able to run, walk and
work) rate is much more than fatality rate.

Silica Dust:
Before detailed description of prevention methods from Silica Dust, we need to understand some basic studies on
Dust to mitigate the risk of fatal health hazards associated with Silica Dust also to make the outcomes foreseeable.

Mostly people exposed to two types of dust with respect to its size, inhalable dust (particle size 10-100 micron) and
respirable dust (particle size 04-10 microns). Respirable dust being light in weight, mostly remain suspended in air as
an air pollutant and also known as RSPM (respirable suspended particulate matter). Because of very small size, It
easily enters the lungs and deposit in lungs permanently. Silica Dust particle size is up to 5 micron, since it’s a
respirable particle that is why Silicosis is an irreversible chronic fatal disease. Once developed can never be cured
but fortunately silicosis is a 100% preventable hazard. Crystalline silica is the basic component of soil, sand, granite
and many other geological origin materials and is classified as a human lung carcinogen. It is the second most
common mineral found in the earth crust, Crystalline Silica is found as Quartz, Cristobalite and Tridymite.

Silica Occurrence in Industry:

Quartz is most common form of crystalline silica which is widely used in Glass, Ceramic and Cement Industry, but
other than these industries high level emission of silica dust occurs during abrasive/sand blasting, stone and marble
crushing and grinding operations which are openly carrying out even as outdoor jobs in Manghopir (Karachi) without
any legal restrictions and reasonable controls to keep the general public safe from catastrophic outcomes of fugitive
silica emissions.

Activities with high level dust exposure include stone and marble crushing, grinding, milling, excavations, earth
moving, mining, use of power tools like hilti, jack hammer, concrete breaker, dry core cutting, drilling, sand blasting,
point source emissions like dry feed charging in uncovered hoppers, uncontrolled fugitive dust emissions, etc.

Silicosis:
Prolong exposure with such polluted ambience having silica particles cause complains of multiple breathing disorders
including shortening of breath, plural masses development in lungs, bronchial asthma, cough, allergies, chest
infections, cardiac respiratory issues, acute respiratory infection, dust pneumonia, tuberculosis, chronic obstructive
pulmonary disease (COPD), Scarring of lung tissues, fibrosis and much other chronic disease ultimately leading to
Lung Cancer and Silicosis, a type of pneumoconiosis. Silicosis is divided into 3 categories, Chronic, Accelerated and
Acute Silicosis. Most common form is Chronic Silicosis typically take 10-20 years to develop. On higher exposures
Accelerated Silicosis (progressive massive fibrosis) develops in 5-10 years. Rarest form is Acute Silicosis that may
develop in few weeks on continuous exposure with extremely high silica dust. General symptoms of Silicosis include
Shortness of breath, Cough, Fatigue; Rapid breathing with pain, Loss of appetite, Weight loss, Chest pain, Fever,
Blue skin, Gradual dark shallow rifts in nails eventually leading to cracks (as protein fibers within nail beds are
destroyed) and Respiratory insufficiency. Health issues other than breathing disorders include skin allergies, dryness
of skin, irritation to the eyes and eye conjunctivitis, etc. Silica dust reduces lungs ability to extract oxygen from air.

Respiratory Affects:
Air contains 21% Oxygen, exhaled air from healthy lungs contain 16% oxygen, i.e., 5% consumption per breath. A
human being uses about 550 liters of pure oxygen (19 cubic feet) per day including low breathing rate during 8 hours
sleep. Tidal volume of lungs is 0.5 liters, i.e., amount of air taken into the lungs in a single breath. An adult person
has respiratory rate of 16 breaths / minute, hence 7 to 8 liters air inhaled per minute. Pure oxygen in 8 liters of air is
1.6 liter and body consumed/absorbed oxygen is 0.4 liter/min to maintain Oxygen Saturation of human body between
95 to 100%. When lungs capacity of oxygen absorption reduces, it results in dropping of oxygen saturation, to
maintain dissolved oxygen level of human body, pulse rate increases simultaneously to speed up the supplies of
blood (into lungs) carrying hemoglobin (a blood protein) that transport oxygen to whole body. Continuous high Pulse
rate (i.e., on or above 100) is an indication of serious heart problems. Deficiency of oxygen also causes
unconsciousness, coma and irreversible brain injuries.

Controls:
Industrial application of Silica/Quartz can be made safe by means of implementation of some impact mitigating
engineering and administrative control measures like Local Exhaust Ventilation (LEV), Dust Hoods, Electrostatic
Precipitators, Bag Houses, Dust Cyclones, HEPA (High Efficiency Particulate Air) Filters, Bag Filters, Dust
Suppression by Damping Down Method, Vehicle Speed Limit Controls to overcome FRD (Fugitive Road Dust)
issues, Isolation of Point Source Emissions, use of wet technologies instead of dry methods for drilling, cutting and
sawing, regular air monitoring using particulate counter devices to asses PEL (permissible exposure limits), positive
pressure inside acoustic havens of Crushers and Mills control rooms, overhead mobile dust suckers, HAZCOM
implementation, awareness by safety briefing/talks, wall posts, signages, demarcation of mandatory PPE/RPE zones,
trainings on proper use of respirators, regular health monitoring and provision of Dust Masks and suitable RPEs
(Respiratory Protective Equipment) to the workers who are routinely exposed with such hazards.

Legislation:
Sufficient legislations in Sindh province are covering these issues including SEPA Act 2014 & SEQS Rules 2014,
Sindh Factories Act 2015, Mines Act 1923, etc. According to SEPA Act 2014 - Part (V): Prohibitions &
Enforcement - Section 11 (2) & (3), “All persons, in industrial or commercial or other operations, shall ensure
compliance with the Environmental Quality Standards for ambient air, drinking water, noise or any other Standards
established, shall maintain monitoring records for such compliances; shall make available these records to the
authorized person for inspection; and shall report or communicate the record to the Agency as required under any
directions issued, notified or required under any rules and regulations. Monitoring and analysis shall be acceptable
only when carried out by the Environmental Laboratory certified by the Agency as prescribed in the rules”. SEQS
Rules 2014 categorize industries with respect to the nature of environmental impacts associate with the unit
processes and unit operations of industries in the form of effluents discharge, Dust and Air Emissions.

Similarly, Chapter (III) – Section 18(1) of Sindh Factories Act 2015 declares, “In every factory in which, by reason
of the manufacturing process carried on, there is given off any dust or fume or other impurity of such a nature and to
such an extent as is likely to be injurious or offensive to the workers employed therein, effective measures shall be
taken to prevent its accumulation in any work-room and its inhalation by workers and if any exhaust appliance is
necessary for this purpose, it shall be applied as near as possible to the point of origin of the dust, fume or other
impurity, and such point shall be enclosed so far as possible.”

According to Section 25(1), “Each worker in a factory shall be provided with a "hygiene card' in which during the
month of January and July every year the entries shall be recorded after examination by appointed factory doctor to
the effect that the worker is not suffering from any contagious or infectious disease. Moreover, Section 14(2)
articulates, “A certifying surgeon may authorize any registered medical practitioner to exercise any of his powers
under this Act: Provided that a certificate of fitness for employment granted by such authorized practitioner shall be
valid for a period of three months only, unless it is confirmed by the certifying surgeon himself after examination of
the person concerned.”

Civil Petition – Human Rights Case:

Supreme Court of Pakistan recently announce a decision on 9th April 2018 after final hearing of a Human Rights
Case # 16143-P/2014 regarding Fatal Lungs Disease Silicosis and its prevention. As per directives of Honorable
Supreme Court of Pakistan, Mines & Minerals Development Department (Govt. of Sindh) took appreciable initiatives
and Chief Inspector Mines under the supervision of Secretary Mines & Minerals invited relevant industry (mining,
stone/marble crushing/grinding and cement) representatives to inform about the requirements and implications of
SCP Orders on 26-04-2018 at Inspectorate of Mines, Karachi.

As per SCP Orders Section C (iii): Prevention & Protective Measures; Being a potential source to cause Silicosis, all
Cement Factories be directed to establish a Silicosis Diagnostic Center in their factories to monitor the ill effects of
inhalation of dust particle emitting from various processes carried out for the manufacturing of Cement. Section C
(vi): The employers are obligated to ensure compliance to safety standards at workplaces, the provision of a
“Hygiene Card” to every worker and compulsory vaccination and inoculation of all workers, to have an
emergency/disaster management plan to cater to any emergency situation. Section F(ii): Awareness; For Safety, a
worker is required to wear protective clothing specified for the work and no person can be engaged in hazardous
work/occupation unless the certifying surgeon has provided the certificate of medical fitness for such work.

Diagnosis:
Unfortunately there was no proper Silicosis Diagnostic Center established in Pakistan for general public. Recently
many Cement Factories established Silicosis Diagnostic Centers in their factory premises for biannual health
monitoring of employees. Silicosis primarily can be diagnosed by employing PFT (Pulmonary function test),
Spirometers, Peak Flow Meters, Pulse Oximeters to diagnose Oxygen Saturation, Lungs Functional/Breathing
Capacity, symptoms of plural masses, etc. After screening of workers through this primary diagnostic method,
identified critical cases will go through Digital Chest X-Ray. It is pertinent to mention here that Chest X-Ray frequency
must not exceed once in two years otherwise it causes serious damages to lungs. Cases identified with plural
masses development in lungs through digital chest X-Ray shall undergo through High Resolution CT Scan as the
most authentic Silicosis screening method.

Cause of Failure to Control:

Regrettably most of the occupations involving silica exposures are of temporary nature jobs like construction, mining,
sand blasting, quarrying, masonry, stone cutting, etc. Due to which in Pakistan, there is no reliable control available
for regulatory bodies regarding health monitoring of workers involved in such jobs. A huge number of workers from
rural areas visit cities/urban areas in search of temporary nature (daily wages) jobs and return to their native areas
after a short span of time on completion of work. A worker with diagnosed chronic silica cannot be used as a source
to develop a case study for root cause analysis because a daily waged worker provides his services to thousands of
employers during 20 to 25 years of his average work life. Due to lack of traceability and absence of diagnostic
facilities, thousands of silicosis patients die every year in Pakistan considering the disease as an adverse type of
asthma or cardiac arrests with cause of death generally identified as cardio respiratory failures. At least millions of
workers can still be observed with bluish nails, chronic cough, tuberculosis, COPD and many other lungs disease but
the deaths rate caused by silicosis is off the record in all 3rd world countries. There is a dire need of proper
awareness generally to the workers and particularly to the doctors as the awareness level of Chest Specialists of
JPMC (Jinnah Hospital) Ward 5 (Pulmonology & Chest Ward) is also found inappropriate regarding Silicosis and its
Diagnostic Methods.

Socioeconomic Implications:
It is the duty of corporate sector to comply with all legal requirements pertaining to occupational safety and health for
sustainable socioeconomic development of our national human capital in terms of competent workforce. Otherwise
dust illnesses and disease like silicosis will adversely affect the economic condition of Pakistan as such occupational
disease significantly reduce efficiency, productivity and work-life of useful and skilled manpower. Locally available
cheap labour strengthens the economy and stabilizes the currency value circuitously in terms of enhanced liquidity,
positive cash flows, controls inflation and attracts foreign investors.