1. Preventing Chronic Beryllium Disease through Exposure Recognition and Control Training for Beryllium Exposed Workers Training Developed by:

2. 2 Disclaimers This material was produced under grant number SH-20996-SHO from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U. S. Government. This training is not intended to replace site or company specific training on the recognition and control of beryllium hazards in the workplace. Photos shown in this presentation may depict situations that are not in compliance with applicable OSHA/safety requirements. It is the responsibility of the employer and its employees to comply with all pertinent OSHA/safety rules and regulations in the jurisdiction in which they work.

3. Definitions Microgram (µg) –A small unit of weight –Equal to 1/1000 of a milligram (mg) –1 grain of salt = 100 µg Beryllium Exposure –Inhalation of beryllium particles –Skin contact with beryllium particles Beryllium Sensitization (BeS) –An allergy to beryllium Chronic Beryllium Disease (CBD) –Lung disease in some people with BeS 3

4. 4 Outline Introduction to OSHA Overview of beryllium Health effects of beryllium Recognizing and controlling beryllium exposure Medical surveillance (routine medical testing of workers for beryllium health effects)

5. Introduction to OSHA

6. 6 What is OSHA? Occupational Safety and Health Administration Government agency within the U.S. Department of Labor Responsible for worker safety and health protection Created in 1970 by the Occupational Safety and Health (OSH) Act OSH Act allows states to take responsibility for implementing OSH Act providing their regulations are at least as stringent as Federal OSHA

7. 7 What does OSHA do? Requires employers to implement programs to reduce workplace safety and health hazards Investigates workplace fatalities or catastrophic accidents Enforces safety and health standards through workplace inspections by compliance officers Monitors job-related injuries and illnesses through required record-keeping Provides assistance, training, and other support programs to help employers and workers

8. 8 What are employers’ responsibilities under OSHA? Provide employment and a workplace that is: 1.Free from recognized hazards that are causing or are likely to cause death or serious physical harm to employees. 2.In compliance with established OSHA standards.

9. 9 Are there specific OSHA standards that apply to my workplace? Recordkeeping Housekeeping Medical & First Aid Walking/Work Surfaces Emergency Action Noise Hazardous materials –Compressed gases –Flammable liquids Personal protective equipment Confined spaces Lockout/tagout Fire protection Powered industrial trucks Cranes Machine guarding Electrical Respiratory protection Exposure to toxic substances Hazard communication There may also be others that apply to your workplace!

10. 10 Does OSHA have a specific beryllium standard? Federal OSHA –Less than 2 µg/m 3 as an 8-hour average –Can be between 5 µg/m 3 and 25 µg/m 3 for up to 30 minutes in an 8-hour shift –Must never exceed 25 µg/m 3 –Compliance with these levels may not prevent chronic beryllium disease CalOSHA –Less than 0.2 µg/m 3 as an 8-hour average –Must never exceed 25 µg/m 3 Federal OSHA is currently working to revise the standard for beryllium exposure

11. 11 What are employees’ rights under OSHA? 1.Get training from your employer as required by OSHA standards 2.Request information from your employer about OSHA standards, worker injuries/illnesses, and job hazards 3.Request action from your employer to correct hazards or violations of OSHA standards 4.File a complaint with OSHA if you believe there are violations of OSHA standards or serious hazards Must be submitted in writing, signed by a current employee or employee representative, and state the reason for the inspection request Forms and more information available at www.osha.gov

12. 12 What are employees’ rights under OSHA? 5.Be involved in OSHA’s inspection of your workplace 6.Find out results of an OSHA inspection 7.Get involved in meetings or file a formal appeal concerning your employer’s timely abatement of OSHA citations 8.File a discrimination complaint 9.Request a research investigation by the National Institute for Occupational Safety and Health (NIOSH) 10.Provide comments and testimony to OSHA during rulemaking on new standards

13. Overview of Beryllium

14. What is Beryllium? Forms –Metal –Ceramic (Beryllia) –Alloys (BeCu, AlBeMet) –Contaminant in bauxite, alumina, recycled metals Properties –3X lighter than aluminum –6X stiffer than steel –Conducts heat well –Dimensionally stable –Transparent to X-Rays –Reflects neutrons 14 All Photos © 2011 periodictable.comperiodictable.com Used with written permission for non-commerical use

15. 15 Beryllium Uses Airplane and Space Industries Nuclear Reactors Computers, Phones Automobile Industry Dental alloys Contaminant in aluminum smelting and metal recycling Estimated 2010 consumption – 620 metric tons Photo by NASA available under public domain from Wikimedia Commons Wikimedia Commons

16. Health Effects of Beryllium

17. 17 Health Effects of Beryllium Lungs –Acute beryllium disease –Lung cancer –Beryllium sensitization (BeS) –Chronic beryllium disease (CBD) Skin –Several skin effects –BeS Skin Breathing Routes of ExposureHealth Effects Illustration by National Jewish Health

18. 18 Skin Effects Slow wound healing Nodules –Response to beryllium under the skin Allergic rash –Beryllium salts BeS –Broken skin & cuts –Rash –Even unbroken skin may not be a complete barrier Photo by National Jewish Health All broken skin and cuts should be covered Covering the skin may reduce the risk of BeS Nodules

19. 19 Lung Effects: Acute Beryllium Disease First recognized disease from beryllium Severe lung disease soon after exposure –Similar to pneumonia –5-10% died –Most of the others recovered in < 1 year Many later developed CBD Due to very high level exposures –50-1,000 µg/m 3 –very uncommon in recent years –possible after extremely high release Elevated risk of lung cancer Photo by BArchBotavailable under public domain from Wikimedia Commons Wikimedia Commons

20. 20 Lung Effects: BeS & CBD BeS (Beryllium Sensitization) –An allergy to beryllium –BeS causes no symptoms –2 abnormal beryllium tests (BeLPTs) –Workers with BeS can develop CBD CBD (Chronic Beryllium Disease) –Inflammation –Possibly scarring in the lungs Most exposed workers will not get BeS or CBD Low levels of exposure decrease but do not eliminate the risk of BeS and CBD

21. 21 Are YOU at Risk for BeS & CBD? + → → Your Genes Beryllium Exposure Less than 1% to 16% of workers tested have BeS The number depends on level of exposure and industry Some workers with BeS had very low exposure Some workers who are not sensitized on the first test later become BeS 10% to 100% of workers with BeS develop CBD No immune response Immune response Illustration by National Jewish Health Illustration by US DOE available under public domain from Wikimedia CommonsWikimedia Commons Beryllium Sensitized Exposed, Non-sensitized CBD Be

22. 22 Beryllium Sensitization Normal Response Abnormal Response =+ Immune cell = + No Response Immune cells multiply Beryllium Sensitization Illustration by National Jewish Health Be Determined by exposure and your genes

23. 23 NormalCBD Normal CBD Oxygen easily passes into bloodLimited oxygen passes into blood Oxygen Photo by National Jewish Health Illustration by National Jewish Health →

24. 24 Symptoms of Chronic Beryllium Disease No symptoms initially Gradually worsening –Cough, usually dry –Shortness of breath First noticed with physical activity –Sweating at night –Feeling tired all the time In some cases, severe shortness of breath Can be mistaken for other lung diseases –May be misdiagnosed if BeLPT not done If you have these symptoms, tell your doctor that you are exposed to beryllium Photo by National Jewish Health

25. 25 Treatment of CBD THERE IS NO CURE No symptoms –No treatment Mild symptoms –Inhaled medication Increasing symptoms/worsening lung tests –Steroid pills (ex. Prednisone) Worsening disease and lung function –Other medications Severe disease –Use of oxygen Photo by National Jewish Health

26. 26 How do we test for BeS and CBD? Means immune cells multiply (proliferate) when exposed to beryllium Abnormal immune response seen in both BeS and CBD Test does not mean high exposure to beryllium A medical evaluation is needed to know if you have CBD Beryllium Lymphocyte Proliferation Test (BeLPT) Photo by National Jewish HealthIllustration by National Jewish HealthPhoto by US Navy available under public domain from Wikimedia Commons Wikimedia Commons

27. 27 Blood cells Normal Blood cells multiply Abnormal BeLPT: Blood Test for BeS and CBD Blood cells Illustration by National Jewish Health Be

28. BeLPT Results Normal (Negative) Abnormal (Positive) Borderline –Not normal and not abnormal –Test needs to be repeated –Repeat test usually normal Uninterpretable –Test did not work –Test needs to be repeated 28 Be * *

29. 29 BeS = 2 Abnormal BeLPTs BeLPT is not a perfect test –A single abnormal needs to be confirmed (repeated) –Only commercially available test for BeS (currently) Medical evaluation for CBD after 2 abnormal BeLPTs (confirmed sensitization) is standard medical practice Also recommend medical evaluation for CBD: –3 borderline BeLPTs –1 abnormal + 1 or more borderline BeLPTs

30. 30 Medical Evaluation History and examination Pulmonary function tests –Breathing tests Exercise tolerance test –Includes tests for oxygen CT (CAT) scan/chest x-ray Bronchoscopy –Collect immune cells from the lung Examine type of immune cells present Perform BeLPT –Biopsy of lung tissue Granulomas: Abnormal collections of cells Photo by National Jewish Health

31. 31 When can you get BeS and CBD? Within 3 months After many years Many years after last exposure –Beryllium stays in the lungs Even after a normal BeLPT Any time after first exposure to beryllium

32. Beryllium Exposure Recognition & Control

33. 33 How can I be exposed to beryllium at work? Particles produced by work processes Particles blown from: –Work surfaces –Clothing –Floor Particles from nearby work processes Skin contact with: –Be parts –Contaminated surfaces Photo used by National Jewish Health with written permission

34. 34 How do I know if I could be exposed? If beryllium is used in your workplace you might be exposed Workers likely exposed: –Machinists –Production workers –Maintenance workers –Cleaning personnel –Laboratory –Shipping & Receiving Others that might be exposed: –Front office workers –Security guards –Family members of workers Photo by National Jewish Health

35. 35 How is beryllium measured? Air samples –Measure the amount of beryllium in air –Estimate the amount a worker might inhale into their lungs –Different types of air samples: Personal samples Area samples Surface or Wipe Samples –Measure the amount of beryllium on a surface –No consistent relationship to airborne beryllium exposure Photo by National Jewish Health

36. 36 How is beryllium exposure measured? Personal samples measure exposure –Workers wear sampling pump for entire work shift –Best estimate of worker exposure –Meets OSHA requirements Area samples: Sampler placed in work area –Measure air levels in non-beryllium areas –Check control measures –Area samples DO NOT measure worker exposure Photos by National Jewish Health Worker “wears” sampling pump Filter in “breathing zone” Beryllium collected on filter and tested by laboratory

37. 37 What do airborne beryllium levels mean? Normal outside air –Average 0.00003 µg/m 3 Lowest level that can be measured –Approximately 0.015  g/m 3 –Cannot measure ZERO Current Federal OSHA standard: –2.0  g/m 3 (8 hour avg) (may not prevent CBD) CalOSHA standard and U.S. DOE Action Level –0.2  g/m 3 (8 hour avg) ACGIH Threshold Limit Value –0.05  g/m 3 (8 hour avg) There is no level that assures zero risk of BeS or CBD 1 grain of salt = 100  g 0.2  g/m 3 = 4 grains of salt in air filling the size of an Olympic pool. Photo by National Jewish Health

38. 38 Does chemical form of beryllium matter? No known differences in CBD risk –Pure beryllium metal –Beryllium alloys Beryllium copper, AlBeMet –Beryllium composites (E-materials) Possibly lower CBD risk –Beryllium silicates Beryllium in soil and rocks –Soluble beryllium (salts) Beryllium fluorides and sulfates Possibly higher CBD risk –Beryllium ceramic –Beryllium oxide Photo used by National Jewish Health with written permission

39. 39 Is particle size important? Particle size effects where beryllium settles in the lung Most industrial processes produce many particles less than 1 µm (invisible to unaided eye) Processes with smaller particles have higher rates of CBD/BeS –Lapping –Machining Small particles can spread throughout the building –Settling time (still air – 2 m) 100 µm – 8 seconds 10 µm – 10 minutes 1 µm – 15 days Figure by National Jewish Health Sizes not actual, Relative size comparison

40. 40 Is skin exposure important? Beryllium can enter damaged or cut skin Beryllium dissolves in sweat and may get through skin Very small particles may get through skin with force or pressure Cover the skin to reduce the risk of beryllium sensitization (BeS) Assembly/Deburr270 µg Machinists220 µg Maintenance74 µg Administration0.44 µg After hand washing Up to 220 µg Photo by National Jewish Health Beryllium Hand Wipe Samples

41. 41 Is “take-home” exposure important? Airborne beryllium has been measured while washing work clothes at home Cases of BeS and CBD have been seen in family members of beryllium workers Changing clothes, changing shoes and showering is important to prevent take-home exposure. Steering Wheel: Up to 5.3 µg/100 cm 2 Driver’s floor: Up to 76.8 µg/100 cm 2 Driver’s seat: Up to 15.9 µg/100 cm 2 Driver’s armrest: Up to 39.7 µg/100 cm 2 Photo by National Jewish Health Beryllium in wipe samples from workers’ personal vehicles

42. 42 How are beryllium exposures controlled in the workplace? Combined efforts needed to prevent and control beryllium exposure –Engineering controls –Work practice controls –Administrative controls –Personal protective equipment (PPE) –Medical surveillance Photo used by National Jewish Health with written permission

43. 43 What are engineering controls? Wet methods –Machining fluids Ventilation –Local Exhaust Ventilation (suction) Enclosures Facility design –Hard cleanable surfaces –Separation of beryllium and non-beryllium processes –Separate ventilation systems Photo used by National Jewish Health with written permission

44. 44 Wet Methods + Local Exhaust Ventilation Photo used by National Jewish Health with written permission

45. 45 Enclosure + local exhaust ventilation Photo used by National Jewish Health with written permission

46. 46 What are work practice controls? Proper use of engineering controls (all the time) Labeling of all beryllium materials Use industrial HEPA vacuums NO compressed air for cleaning Wet wiping and mopping only NO dry sweeping No eating or drinking in beryllium contaminated areas Education is critical for success Photos used by National Jewish Health with written permission

47. 47 What are administrative controls? Restrict entry to beryllium areas Limit number of exposed workers Make sure contractors understand work practice controls Limit spread of beryllium Work uniforms Shoe covers Sticky mats Designated change areas Clean break area Dennis Myts, Wikimedia Commons – CC-BY-SA-2.5 Wikimedia Commons Changing clothes, changing shoes and showering is important to prevent take-home exposure.

48. 48 What is personal protective equipment? Skin protection –Long sleeve work uniforms of tightly woven material –Gloves required when skin contact with beryllium possible Respirators –Recommended (required in California) for exposures that cannot be controlled to at least 0.2 µg/m 3 with engineering controls or to keep exposures as low as possible Must be used correctly (no facial hair) Must be used when required Must be medically cleared and fit-tested Proper training is necessary PPE is only effective when used properly Photo by National Jewish Health

49. What is medical surveillance? Medical testing for health effects from a hazardous substance –Earlier diagnosis and treatment of disease Counseling to minimize exposure –Can identify places of higher risk exposure Places where exposure controls may need to be improved Beryllium medical surveillance –Routine testing with the BeLPT One time testing is not enough! Photo by US Navy available under public domain from Wikimedia Commons Wikimedia Commons 49

50. Why do medical surveillance? To determine if exposure controls are working “Safety net” for exposure control If no BeS is identified in your workplace Helps confirm that your exposure controls are working If BeS is identified in your workplace Suggests your exposure controls need to be improved That other workers in similar jobs may be at risk 50

51. 51 What is included in a beryllium exposure control program? Management leadership Clear employee expectations and training Methods to prevent spread of beryllium Effective exposure controls –Establish exposure target level –Engineering controls –Work Practice Controls –Proper Use of Personal Protective Equipment Frequent measurement of worker exposure Routine medical surveillance Written plan Record keeping

52. 52 Questions? Photo by National Jewish Health This material was produced under grant number SH-20996-SHO from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U. S. Government.