Silicosis

Abstract

Occupational exposures to dust with elevated levels of respirable crystalline silica in artificial stone increase workers’ risk for silicosis.

Silicosis is an incurable but preventable disease caused by inhalation of respirable crystalline silica dust. Based on outbreaks in other countries, the Occupational Safety and Health Administration (OSHA) along with the National Institute for Occupational Safety and Health (NIOSH) warned about the silica health hazards for workers involved in manufacturing, finishing, and installing manufactured stone countertop products (OSHA & NIOSH, 2015). Manufactured, engineered, and artificial stone (AS) describe the commercial product that combines silica with a binding agent to produce a stone-like countertop, commonly called “quartz.” The silica percentages in natural stone vary, but AS surfaces can be over 93% silica. Grinding, cutting, drilling, and polishing stone and AS countertops release hazardous silica dust into the air, which creates a widely known and established occupational health hazard (OSHA & NIOSH, 2015). The rapid increase of stone and AS surface imports over the last decade has placed increasingly large numbers of workers at risk of silicosis in the United States and globally. Dodd and colleagues (2019) noted silicosis outbreaks in the United States, Australia, Israel, and Spain. An estimated eleven million or more workers in India are exposed to silica dust, and the booming mining industry of China puts untold numbers of workers at risk; increased cases have also been seen in Turkey among workers who sandblast denim used for faded jeans (The Lancet Respiratory Medicine [TLRM], 2019).

Inhaling respirable crystalline silica dust can cause fibrosis and lung inflammation, which over time leads to silicosis; scarring creates permanent, and sometimes fatal, lung damage (Dodd et al., 2019). Workers exposed to micro-sized silica dust have an increased risk of developing chronic obstructive pulmonary disease (COPD), pulmonary tuberculosis, kidney disease, autoimmune disorders, lung infections, cardiovascular impairment, and lung cancer (Dodd et al., 2019; NIOSH, 2002). Silicosis is a progressive and irreversible disease, without specific treatment options; depending on their condition, patients may have lung transplants (TLRM, 2019).

Employers and workers may not understand the risks associated with silica dust exposures, especially from AS. Occupational health nurses can offer education about risk factors and preventive strategies at the worksite and in the community. Primary preventive measures include using wet-cutting saws and localized dust extraction systems, educating and training about silicosis and its prevention, providing NIOSH-approved respiratory protection, and collecting air samples for environmental monitoring (Leso et al., 2019). Employers must comply with state and federal OSHA standards to assure employee exposures remain below the permissible exposure limit for respirable crystalline silica of 50 micrograms per cubic meter of air (50 µg/m³), averaged over an 8-hour workday (Dodd et al., 2019).

Health care providers should know about this occupational threat, which may not surface until 10 or more years after exposure. Symptoms of silicosis include fatigue, cough, shortness of breath, and/or chest pain (OSHA & NIOSH, 2015). Health surveillance programs may find silicosis early and help minimize its potential severity (Leso et al., 2019). Health care providers should report suspected cases of AS-related silicosis to local and state health departments (Dodd et al., 2019). The cause and prevention of silicosis is well documented, yet the global workforce continues to suffer its adverse health effects. Increased education and awareness can help protect natural and artificial stone workers from the adverse health effects of silicosis.