Sun Safety at Work Canada

AN OCCUPATIONAL HEALTH AND SAFETY MANAGEMENT SYSTEM APPROACH TO

ADDRESSING SUN SAFETY

Brenda M Marsh, RN, COHN(C), CRSP, CHSC Occupational Health Nurses Association of Nova Scotia

Nov 18, 2016

What is Sun Safety?

• Measures taken by a workplace to manage outdoor worker exposure to the sun, and help prevent:

– Adverse eye and skin conditions from over-exposure to solar UV radiation (e.g. skin cancer, photokeratitis)

– Heat-related conditions from heat-stress associated with exposure to the sun in combination with physical activity or outdoor work

Project Design

Interviews, Worker surveys, document analysis, observation

Baseline Eval

“Action Plans” – workplaces planned what they would do

Maintain contact, provide assistance

Refine & implement initiatives

Interviews, Worker & OHS Lead surveys, UV dosimetry

Final Eval

Re-engage, OHS & Management interviews

Midpoint Eval

https://sunsafetyatwork.ca/a bout-us

Winter 2016Summer 2015Spring/ Summer 2015

Fall 2016Summer 2016Spring 2016

Municipalities

Electrical Utilities

University

British Columbia

Ontario

Nova Scotia

SSAWC Project Overview

2014 2015 2016

Phase I: Workplace Trial• Develop, implement, and

improve sun safety programs at trial sites Develop Resources

Phase II: Broader Reach

• Develop the website• Engage intensively with

stakeholders

T2T1

Action Plan

Final

Phase I Evaluation

T3

Workplace Reports

Baseline

Occupational Sun Exposure

• # Outdoor workers in Canada: 1.5M(8.8%) (CAREX Canada, 2012) to 5.4M (26%) (Marrett et al, 2010)

• When assessed, outdoor work exposures are often many times the TLV/OEL

• Canada – Levels of Exposure: (Peters etal, 2012)

– Low: almost never exposed – truck & delivery drivers

– Moderate: indoor/outdoor mix – crane operators, carpenters, maintenance labourers, couriers

– High: >75% outside – farmers, construction

(OCRC & CAREX, 2016)

Occupational Sun Exposure & Skin Cancer

Canadian Burden of Occupational Cancer Project:

• 4560 non-melanoma skin cancers each year attributed to occupational solar radiation

Comparison:• Asbestos: 1900 lung cancers

& 430 mesotheliomas• Diesel engine exhaust: 560

lung cancers & 200 suspected bladder cancers

• Crystalline silica: 570 lung cancers

(OCRC & CAREX, 2016)

Occupational Sun Exposure & Heat Stress

• Heat stress is a spectrum of disorders that can occur because of sun exposure, heat, and physical activity (CDC, 2013)

• Most serious form is heat stroke, which as irreversibly damage the heat, kidney, and liver, and can result in death (Chao et al., 1981)

• Heat stress is more common in outdoor workers (CDC, 2008)

• Solar radiation is the primary source of heat stress for outdoor workers (Ontario Ministry of Labour, 2012)

Image provided by Queensland Department of Health

Sunburn

• Damage to the genetic material in your skin

• Sunburn once every 2 years can triple the risk of melanoma

• Swelling, as blood rushes to the surface, tries to rehydrate, immune system fights back releasing painful chemicals

Sun Safety Programs

• Apart from Be Sunsible in AB (www.besunsible.ca), there are no occupational sun safety programs delivered in Canada

• ‘Interventions in outdoor occupational settings to prevent skin cancer’ are ‘recommended’ based on ‘strong evidence of effectiveness in increasing outdoor workers’ sun protective behaviors and reducing sunburns’ (Community Preventive Services Taskforce, 2013)

• There are no occupational sun safety programs in Canada that address both skin cancer and heat stress or embed sun safety within an OHSMS → Sun Safety at Work Canada

Sun Safety Programs – our approach

• Workplaces should consider sun exposure like any other workplace hazard and manage it the same way as other hazards, i.e. through an OHSMS

• For workplaces with outdoor workers, a Sun Safety Program (SSP) should be part of an organization’s OSHMS.

• The SSP is focused on prevention and management of health risks associated with sun exposure within the workplace.

• OHSMS is based on the Plan-Do-Check-Act model of improvement

Model Sun Safety Program

Sun Safety ‘Lens’• Sun Safety Elements?• Solar UV Exposure?• Heat Stress?

Primary Prevention

• Coach your employees re: the harmful effects of solar radiation on their skin, eyes and immune system and how to avoid them.

• Educate them re: control measures. –Reduce the risk by approximately by 45%.–Lessen the need for surgery, pain, disfigurement–Improve health of EEs–Decrease time away from work–Maintenance of productivity levels–Lower costs to health benefit program–Lower costs to health care system

Three (of 200) Forms of Skin Cancer

• 50 Nova Scotians per week diagnosed skin cancer

• Basal cell carcinoma (BCC) non-melanoma • Squamous cell carcinoma (SCC) non-melanoma • Melanoma – the deadliest form

? Most Common Type of Cancer?

• Skin cancer - 73,000 new cases of cancer in 2008–4,600 cases of melanoma skin cancer–73,000 cases of non melanoma skin cancer (2,360 NS)

• Rates are increasing

• Nova Scotia & PEI - highest rates in the country

Skin Cancer Risks• You Cannot Change

• fair skin that tans poorly or burns• blonde, red or light brown hair• light coloured eyes - blue, grey, or green• freckle easily• large number of moles• family history of skin cancer• A tendency to burn rather than tan

• You CAN Change• repeated sunburns• work outdoors• outdoor activities• use of tanning beds• sun bathing• prolonged exposure to the sun

Increase in Skin Cancer – Why? • Changes in ozone layer• Involvement in outdoor activities• Modern clothing exposes more skin• Decreasing amounts of stratospheric ozone which

partially protects the earth's surface from receiving cancer-producing ultraviolet (UV) radiation

• People are moving to sunnier locales• General aging of the population• Tanning the skin is falsely viewed as healthy• Need Vitamin D

UV Rays: Short Term Effects - EYES

• Some industrial chemicals can cause photosensitisation of the eyes (some coal tar derivatives) can damage the outer surface of the eye.

Skin Cancer Causes

• 90% melanomas - UV radiation

Other causes • Chemical exposure

Types of Radiation

• Visible light, which gives us the colours we see, • Infrared radiation which gives us the warmth we feel, and • Ultraviolet (UV) radiation.

• UV radiation can cause harmful effects to the skin

There are three basic types of ultraviolet radiation: • UVA (long-wave UV), • UVB (sunburn UV), and • UVC (short-wave UV).

Artificial Sources of UV Radiation

• Electric and plasma arc welding and cutting tools

• Gas or vapour pressure discharge lamps used in lighting, curing paint, inks

• Bacterial and fungicidal cabinets and lamps

• Solariums and ultraviolet lamps

• Some molten metal presses

PHOTOSENSITISING SUBSTANCES

• Exposure to photosensitising substances can worsen the effects of solar UV radiation

• Ex: coal tar and several of its by-products,• certain dyes, selected plants and fruits • a number of medications (tetracyclines, sulfonamides,

thiazide diuretics, chlorpromazine, oral contraceptives)

UV Rays: Long Term Effects - EYES

• Damage to the cornea

• Cataracts - opacities of the lens of the eye

Pterygia

• Wing-shaped growths of the tissue on the outside of the eye, can grow over the cornea

Immune Suppression

• Overexposure to UV radiation may suppress proper functioning of the body's immune system and the skin's natural defenses.

• All people, regardless of skin color, might be vulnerable to effects including impaired response to immunizations, increased sensitivity to sunlight, and reactions to certain medications.

Canada’s Food Guide

• “In addition to following Canada's Food Guide, men and women over the age of 50 should take a daily vitamin D supplement of 10 µg (400 IU)”

• Deficiency results in impaired bone mineralization, and leads to bone softening diseases, rickets in children and osteomalacia in adults, and contributes to osteoporosis.

Canada - Males Working Outdoors

• 44% seek shade during recreation/38% at work

• Only 23% report wearing sunscreen on their face

• Only 21% said that their employers were sources of information about sun safety

• Most reported that they obtained information from television, magazines, family, and friends

Legal Requirements for Protection

Nova Scotia• Sun Safety Law for Nova Scotia Fact Sheet

Building a Sun Safety Program

Set-Up

• Buy-in• Lead /

work group

Review Current Practice

•Assess & compare with Model SSP ‘elements’

Action Plan

• Identify ‘elements’ for action

•Prioritize & Timeline

•Resources•Responsibility

Implement

• Implement actions as per Action Plan

Review

•Periodically review Action Plan and actions implemented

•Evaluate effectiveness

Continual Improvement

Build Your Own Sun Safety Program

Total exposure to solar UVR during outdoor jobs depends on

• the geographical location of the job• the time of year when outdoor work occurs• the times of the day when outdoor work occurs• the pattern and length of exposure – total amount of

exposure over the day• the availability and use of control measures• work tasks and/or breaks where exposure occur• the presence of reflective surfaces• the presence of photosensitisers• existing sun protection available

Season, Latitude & Altitudes

• The time of the year and the latitude of where you are working

• UV Ray levels - more intense during the summer months and the closer you are the to the equator

• Altitude - the intensity of UV radiation increases around 4% with every 300m rise above sea level

Reflective Surfaces

• UV radiation can reflect from surfaces

• Shiny materials, light coloured concrete and paintwork, reflective building glass, corrugated steel, aluminum roofing, sand, water, some soils and even grass

Office Building Glass

• less than 1% of solar UVR will pass through

• the window absorbs the remaining 99%

UV Radiation & Glass

• Vehicle glass offers some protection from UV radiation • The levels of solar UVR inside a car vary, (side windows

are open or closed or orientation of the vehicle with respect to the sun)

• Plain window glass used in car side windows provides only moderate protection unless clear or tinted film is applied

• Laminated windscreens, made of a tough plastic layer bonded between two panes of glass

• When UV levels are 3 and above - use sun protection in vehicles. This will ensure occupants are protected both in the vehicle and when they leave it.

SUN SAFE CONTROL MEASURES

• Engineering controls (reduce exposure to solar UVR by a physical change to the work environment)

• Administrative controls (reduce exposure to solar UVR by a change in work procedure and the way work is organized)

• Personal protective equipment and clothing (reduce exposure to solar UVR by providing a personal barrier between individual workers and the hazard)

Engineering Controls

• Providing shade from direct sunlight or relocating tasks to shaded areas

• Increase the amount of shade provided: - carry out work in the shade of trees or buildings- move jobs to shaded areas- use portable shade - erect permanent shade structures

Engineering Controls

• Shade examples•Trees•Umbrellas•Canopies•Gazebos•Awnings•Sailcloth•Shade from Buildings

Engineering Controls

• Note:A high degree of attenuation of solar UV radiation can be achieved with ordinary window glass

• Keep vehicle windows up when driving for long periods (tint car glass and window glass for protection against solar)

UVI Category & Sun Protection Message

Administrative Controls

• Establish a system for employees to receive a daily text message reminder of the UV Alert

• Set up a Sun Smart UV Alert sign at key worksite entrance/exit points/bulletin boards

• Change the sign daily to reflect the current forecast • Plan work schedules based on the UV Alert

Administrative Controls

• Reschedule work (before 11 am & after 4 pm) • Alternate employees between indoor & outdoor tasks• Plan work routines so indoor or shaded work tasks are done

during the middle of the day• Environment Canada UV ratings for the day: • http://www.msc-smc.ec.gc.ca/topics/uv/

PPE Tips for Success

• Set an example. Ensure managers and supervisors model the policy & program.

• Educate employees in the use of sun protective PPE (dispel misconceptions about the use of sun protection – see CDA quiz)

• Ensure your workers are aware of all the sun protection control measures and the importance of using each in combination, wherever possible.

Text-Message Reminders to Improve Sunscreen Use

• A Randomized, Controlled Trial Using Electronic Monitoring Arch Dermatol. 2009;145(11):1230-1236.

• To evaluate the effectiveness of cellular telephone text messaging as a reminder tool for improving adherence to sunscreen application.

• Participants who received daily text-message reminders had a mean daily adherence rate of 56.1%.

• Participants who did not receive reminders had a mean daily adherence rate of 30.0%.

Personal Protective Equipment & Clothing

• Sun protective work clothing• Sun protective hats• Sunglasses• Sunscreen

Sun Protection Factor

• SPF refers to the ability of the product (e.g. sunscreen or clothing) to protect skin from UVB rays

• The higher the SPF rating the more protection (SPF 30 provides more protection than SPF 2)

PPE & Clothing - Barriers

• Inconvenient, sticky, smelly• Forgot• Wanted to get a tan• Too hot to wear personal protective clothing• Men less likely to wear sunscreen

S P F

0

20

40

60

80

100%

Har

mfu

l UVB

Ray

s Fi

ltere

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2 4 8 10 15 25 30

Sun Protection Factor

SPF

PPE & Clothing

• Recognized Sunscreens

http://www.dermatology.ca/programs-resources/programs/recognized-products/#!/programs-resources/programs/recognized-products/sunscreens/

• Check the EXPIRY date!

PPE & Clothing

Sunscreen

• Use with other sun protection • No sunscreen offers 100% protection from solar UVR• Apply 30 minutes before going outdoors (so that it can

be absorbed into the skin properly)• Second application 20 minutes later will maximize the

protection • Reapply every two hours, or more often if perspiring• Cover all exposed areas, especially neck, ears,

forehead, nose and hands.• Minimum 30 ml of sunscreen for one full body application

PPE & Clothing

Sunscreen• Should be kept in easily accessible places• Store in a cool place below 30° C• Sunscreen can be bought as a cream, lotion, milk or

gel - avoid aerosols• Apply sunscreen on cloudy days & in winter• Lips also need to be protected - lip balm containing

SPF 30+ • Apply sunscreen before insect repellant (as the

repellant may reduce the effectiveness of sunscreen)

PPE & Clothing

Sun protective work clothing

• Wear clothing that covers as much of the body as possible

• Fabrics that don't let light through work best

• Make sure clothing is loose and comfortable

PPE & Clothing

Sun protective hats

• Wear a wide-brimmed (4 inch) hat (not a cap)

• Attach a back flap to construction headwear to cover the back of the neck

PPE & Clothing

Sunglasses

• UVA and UVB American National Standards Institute (ANSI) Standard Z87.1

• CSA Z94.5-95 Nonprescription Sunglasses • Close-fitting, wrap around style sunglasses • Polarized lenses reduce reflected glare • Safety sunglasses• Fit-overs for prescription glasses

PPE & Clothing

Sunglasses

• Where colour or traffic signal recognition is a necessary requirement of work duties, or where colour distortion could adversely affect the safety and/or health of an employee - ANSI Standard Z80.3, CAN/CSA-Z94.3-99

• Neck retainers

PPE & Clothing

Sunglasses

• Plastic lenses – look for scratch resistant coating

• Check distortion – put on sunglasses, look at a rectangle pattern (i.e. floor tiles). If lines stay straight when you move your head up and down and side to side, then the amount of distortion is acceptable.

PPE & Clothing

Sunglasses – Types of Lenses• Regular lenses - reduce brightness of everything• Polarizing lenses: designed to cut glare due to

reflection. Use for driving & outdoor activities (snow or on water)

• Photochromic lenses - change intensity of UV light (turn darker outdoors, lighter indoors). If used for driving, select fairly dark lenses.

• Flash or mirror lenses - reflect all or part of light instead of absorbing it. No performance advantage, scratch easily.

PPE & Clothing

Sunglasses - 3 Industry Standards

• Cosmetic – lightly tinted, not for use in harsh sunlight. Block 0 – 60 % visible light & UVA rays, 87.5% - 95% UVB rays. Use daytime driving.

• General Purpose – block 60 – 92% visible light & UVA rays & 95 – 99% UVB rays. Use driving & harsh sunlight.

• Special Purpose – Block 97% visible light & 98.5% UVA rays & 99% UVB rays. Suitable for prolonged sun exposure & not for driving.

PPE Tips for Success

• Involve employees in selecting suitable sun protective clothing & hats, sunglasses & sunscreen.

• Select a supplier who is able to respond to the needs of your employees and design/develop new sun protective products.

• Trial new initiatives – samples. Document their feedback, concerns, complaints.

Catchy Slogans

• Protect the skin you’re in• When outside, protect your hide• Slip, Slap, Slop• Pool Cool• Save your hide, when outside• Go Sun Smart• Sunwise • Keep Your top on • Know your Moles

Atlantic Canadians Artificial Tanning

(2008) 11% used artificial tanning equipment, which is similar to the Canadian average of 9%

Females were more likely to have used artificial tanning equipment in the past year than males

• Males - 7%• Females – 15%Use of artificial tanning equipment - most prevalent among

younger adults and declines with age• 16-24 year olds – 23%• 25-44 year olds – 15%• 45-64 year olds – 7%

• Dear Sixteen Year Old Me

Secondary Prevention

• Early recognition of damage to enable them to access the healthcare system as soon as possible to deter the disease process.

• Short Term Effects: Photoconjunctivitis (inflammation of the conjunctiva), Photokeratitis (inflammation of the cornea); are due to the accumulation of photosensitive compounds beneath the skin.

• Painful sensation in the eyes, excessive blinking and tears, the sensation of a foreign body in the eyes, difficulty in looking at strong lights, and swelling of the eyes. Appear within a few hours & often disappear within 2 days.

What is Skin Cancer?

• Abnormal cells• Unregulated growth• Ability to spread from the skin to other parts of

our body

• What can it look like?• A mole• A sore that doesn’t heal• A lesion

Abnormal Skin Changes

Abnormal Skin Changes

Abnormal Skin Changes

Taking Action

Know:

• your family history

• the risk factors for skin cancer

• your own skin

Report any concerns to your doctorEarly detection is critical

M = Moles R = Red hair and freckling

I = Inability to tan S = Severe sunburn K = Kin

Risk Factors for Skin Cancer

Taking Action

Know:

• your family history

• the risk factors for skin cancer

• your own skin

Know your skin: Watch for…

• a new growth

• sores or lesions that don’t heal

• any changes in a birthmark or a mole

Know your ABCDE’s• Asymmetry• Border irregularity• Colour variation• Diameter• Evolution

Asymmetry

A www.dermatology.ca

Border

B

www.dermatology.ca

Colour

C www.dermatology.ca

Diameter

D www.dermatology.ca

Evolution

E

www.melanomafoundation.com.au

Tertiary Prevention

• Return to work • Modified hours• Modified duties• May be restricted to working outdoors during specified hours• Will need time for follow up medical appointments

• Allow those, who has been treated for disease related to solar radiation, to return to work, accommodating for continuing treatment and modifying duties.

• Residual long term effects are damage to the cornea, cataracts.

Tools & Resources – SSaWC Examples…

SSP Element SSaWC Tool or ResourceSun safety policy Fact sheet; Example policies for heat stress, solar UV,

and sun safety, for small & large workplaces; Policy checklist

Responsibility, accountability, authority

Example roles & responsibilities – solar UV, heat stress

Legal & other requirements

Fact sheets – general legal issues, plus fact sheets for each Province

Sun safety risk assessment

Solar UV: risk assessment technical guide; operational review; daily procedureHeat Stress: risk assessment technical guide; operational review; daily assessment; daily monitoring plan

Control measures Fact sheets – personal protection, shade, vehicle windows,

Sun safe job procedures

UV Index poster; Heat stress alert poster; Heat stress warning poster; Fact sheets – acclimatization, work/rest cycles

Tools & Resources – SSaWC Examples…

SSP Element SSaWC Tool or ResourceSun safety training & education

Posters – solar UV, heat stress; Fact sheets – UV prevention, photosensitizing substances, heat stress prevention, heat stress signs & symptoms; Presentations for workers & supervisors – heat stress & solar UV; Personal risk assessments – UV & heat stress; Toolbox talks – solar UV & heat stress; Videos

Inspections Inspection checklist & reportIncidents Incident ReportOff-the-job sun safety

Fact sheet; website with links to self-screening, quizzes, kids activities, etc.

All resources available at our website: www.sunsafetyatwork.ca

Review Your Sun Safe Program When…

• changes in a work procedure which may lead to greater solar UV radiation exposure

• requests/recommendations are received from OHS committees

• conditions associated with a hazard change • new hazard information is received• needs identified in the annual review of accidents,

incidents, inspections, hazardous occurrence investigation reports, OHS audits, and first aid records,

• work practices change• equipment is changed or new equipment is introduced

Effective Sun Safety Programs

Individual + Organizational Active engagement Customizable

EmbeddedWorkplace champion Management support

Thank you!

Production of this presentation has been made possible through financial support from Health Canada through the Canadian Partnership Against Cancer.

Thank you to all of the partners who made this project a success: