Health and safety

INTRODUCTION The three examples in this short chapter reflect personal experience in the industry coupled with involvement in litigation work. Health and safety matters such as protection from falling objects, safety clothing, and the use of mechanical and electrical machines are well documented in company procedures, and are not covered here. The three risk areas discussed here do not seem to have attracted the attention that they should. They should interest not only safety officers but also site managers, operatives and personnel officers. Because the first two sections refer to cement chemistry, it may be helpful to put cement into perspective by comparing it with another chemical that is commonly found on site and in the precast works: concentrated hydrochloric acid. Not only is hydrochloric acid a simple two-element chemical, but it is one of the few acids that is a reducing agent and not an oxidising agent like nitric or sulfuric acid. Hydrochloric acids fuming property, its pungent smell and (usually) delivery in glass carboys, coupled with its ability to etch concrete with accompanying bubbling, cause it to be respected. However, because human skin is generally acidic (except for the eyes), and because that acid is dilute hydrochloric, then provided the skin has no lesions, spillage of fuming hydrochloric acid onto the skin causes little harm. It is not a caustic oxidising acid: it does not attack flesh. Compare cement, which arrives as a dry powder, and commands very little respect. However, it should be treated with a level of safety consciousness that makes hydrochloric acid pale into insignificance. There are two reasons for this, and they are both based upon the fact that water is to be added to cement, which is a multicomponent chemical. First, one of these components is water-soluble hexavalent chromium. Second, caustic alkali is released. These two risk areas are discussed in the first two sections.

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2.1 CEMENT ECZEMA Chromium (chemical symbol Cr) is a minor ingredient in OPC. It is present at a typical concentration of about 6mg/kg or 6ppm (parts per million). As far as is known, this figure represents the total Cr and not the water-soluble part. I have encountered only a few cases of skin problems, and so it is reasonable to assume that UK cements have low contents of soluble chromate. Chromium does not occur in the form of a heavy metal but as a chromate salt. When this salt is present in its hexavalent Cr form it is watersoluble, and it is in this form thatfor some personnel-eczema, dermatitis or, more rarely, skin cancer can occur. There is nothing new in the knowledge of this risk factor; it was first reported over 30 years ago (Burrows and Calnan, 1965). In Denmark, research has been undertaken more recently into ways of inhibiting this risk (Aunstorp, 1989a, b, c). Ferrous sulfate was added to Danish cement, and the effects on operatives before and after this addition were reported. Danish legislation then followed, with a limit on the maximum amount of soluble chromate salt permitted in Portland cements, expressed as ppm of Cr. Aunstorp found that the allergic reaction to the chromate in the cement was a much more significant factor than attrition brought about, for instance, by fresh concrete or mortar being rubbed onto the skin. The Danish research was based upon a real situation, and was not a laboratory assessment. Interestingly, the study found inter alia that the use of protective creams before starting work with concrete did not ease the irritant effect of contact with wet cement. The wearing of protective gloves had only a marginal effect in counteracting any allergy or in inhibiting irritation. Irritation, in all cases, would be the first sign of a skin reaction. The last examination of the Danish cement specification revealed that the maximum limit for the soluble chromate salt, as Cr, was 2ppm. Publications by the Health and Safety Commission/Executive (HSC, 1988a, 1988b; HSE, 1988) drew, seemingly, rather marginal attention to these risks. However, at the time of writing it seems that an updated document is due for publication. 2.1.1 IDENTIFICATION The symptoms of cement eczema are irritation of the contact area, probably accompanied by discoloration and a blotchy appearance. If the effect of cement burns is occurring at the same time (see section 2.2), skin irritation is unlikely to be felt because of the damage to nerve ends. 2.1.2 REMEDIAL Wash affected areas immediately with copious quantities of water, and remove cement-stained clothing. Seek medical advice as soon as possible

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after this, and ensure that there will be no future work likely to result in contact with fresh concrete, mortar or grout. 2.1.3 AVOIDANCE Most people are relatively insensitive to the risk of cement eczema, and so it is advisable to question all personnel at the pre-employment or deployment stages. Has the person and/or any member of that persons family ever been prone to allergic skin reactions or complaints? The 1965 study reported earlier indicated that hereditary factors can play a role in a persons proneness to a reaction. For adequate documentation, the posing of these questions and the answers received need to be accurately recorded. As far as protective handwear is concerned, only waterproof gloves known to be unreactive to chromates should be used. Handcreams only prevent the skin from drying out; they do not offer resistance to the chromate salt. 2.2 CEMENT BURNS Throughout this section the term cement burns has been used. In USA litigation reports and published articles the term concrete burns is generally used. It is the chemistry of the wet cement that causes burns, and so cement burns is probably the more explicit term. Abrasion by the aggregate and/or cement on the skin exacerbates the caustic chemical mechanism involving necrosis that is considered to be responsible. The UK problems I have encountered have generally been where operatives have been kneeling and carrying out floor-topping work. Other cases, such as concrete getting inside a Wellington boot, have been illustrated in the UK press, and these are identified later. Severe injury was suffered in all cases, resulting in the inability of the persons concerned to carry out further manual work. Continuous, permanent pain and unsightly skin grafts were also common. The incidence of cement burns was recorded nearly six decades ago in an American medical journal (Meherin and Schomaker, 1939), but there appears to have been a dearth of reports in the literature for more than two decades thereafter. Rowe (1962) described cement burns as unusual. Many cases of litigation took place in the USA, with Erlin, Hime Associates, a consultancy practice in Illinois, not only acting for claimants but also building up a useful dossier of case histories and references to relevant US legislation. At the beginning of my involvement as an expert witness acting for claimants in a county court case, a close liaison was set up with Erlin, Hime Associates. Their earlier 1980s publication (Hime and Erlin, 1982) had a significant impact upon both US and UK litigation. This US

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publication did not pursue a detailed mechanism of the form that is proposed later. It will be argued that there is a simple theory capable of explaining the cement burn mechanism and of showing why the risk is far more serious than previously considered. Although section 2.1 refers to the possible issue of an updated Health and Safety Executive publication, the two information sheets published nearly a decade ago appear at present to be the sole UK guidance (HSC, 1988a, 1988b). The references therein, together with warnings in documents such as delivery notes and safety instructions, will be highlighted later in the proposed theory as not being detailed enough. One of these publications contains a photograph of a cement burn to the knee of an operative. Three further publications appeared a few years later (Anon, 1993a, b, c). No reference can be made to personal case history experience here as one of the cases was settled out of court and another one is current as at early 1997. It is not known how many cases of cement burns have occurred in the UK without being reported in the press. The pressures being placed upon contractors and subcontractors could have resulted in precautions being sacrificed for the sake of speed and/or economy. However, the apparently low incidence of cement burns in the UK implies that a high quality of care is being exercised on site, in the works and plants. In 1988 Hime and Erlin reported a study where research by others was referenced, without much detail. This stated that trouser material acts as a chemical buffer and increases the alkalinity at the skin, with an increase in pH from about 12.8 to nearly 14. It was not understood how material fabric could cause this, and I have conducted laboratory tests using fresh cement mortar on one side of various fabrics such as worsted, linen, denim and nylon. In all cases the pH was found to be about 12.5 on both sides of all materials tested, with no significant gradients. It is therefore logical to turn to what is known about personnel suffering cement burns on site. Two factors seem to be necessary. First, the spillage needs to be static and in contact with the skin for at least half an hour. Second, the skin where the spillage has taken place needs to be on a relatively warm part of the body. Cement burns do not appear to occur when the operatives hands are in and out of concrete. These two conditions need to be correlated with the known cause of cement burns, which is necrosis, or in simple terms a caustic burning effect on skin, nerves and muscle. The most critical of these three effects is the destruction of nerve ends, because this dulls any feeling of burning or irritation. This is probably why operatives carry on working after spillage, not knowing that flesh burning is continuing. The 1993 Construction News article (Anon, 1993c) describing spillage into a Wellington boot is an example of this. The presence of alkali in the forms of sodium and potassium hydroxides was mentioned in section 1.5 and expressed as Na Oequiv. A typical level
2

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for OPC would be about 0.6%. This is equivalent to approximately 0.4% as sodium hydroxide. This is known as caustic (i.e. it burns flesh) soda. Both the alkaline lime and the caustic soda contribute to the alkalinity of cement paste. What is important is that lime is alkaline without being an alkali, but caustic soda is both. Furthermore, lime is only slightly soluble in water, whereas the alkalis are very soluble. Consider now a realistic scenario: an operative kneeling on fresh concrete so that the chemicals in 1kg of concrete can access the skin. If the cement content is say 350kg/m3, then that 1kg of concrete will contain about 150g of cement, assuming a fresh wet concrete density of 2350kg/ m3. At a 0.4% equivalent caustic soda level the operative is in contact with 0.6g of one of the most caustic chemicals known. Its uniform distribution throughout the contact area explains why body heat and time are jointly required. As body heat causes the water in the concrete to evaporate, the effective concentrations of both lime and the alkalis increase. Lime, being only fractionally soluble in the moisture on the skin, will not cause much distress. The approximate half gram of caustic alkali would be responsible for the necrosis that occurs. This explains why the combined conditions of both warmth and time are necessary, and why a continuous replenishment and/or renewal of fresh concrete with the skin does not apparently cause the same distress. The alkalis do not have the chance to become concentrated by evaporation of the water. In addition, it may be predicted that the abrasion effect of contact with aggregate will have an exacerbating effect on flesh already undergoing necrosis. 2.2.1 IDENTIFICATION The symptoms are soreness experienced after some hours, followed, usually the following day, by severe pain and ulceration, with a flesh colour varying from green to purple and, generally, an accompanying discharge. 2.2.2 REMEDIAL It is possible to ameliorate the situation slightly by immediate washing of the affected area with copious quantities of water, coupled by the removal of all affected clothing. This clothing should be washed or discarded. The US articles referred to earlier advise not to cover the area nor to apply any form of dressing. Immediate hospitalisation is advised with, preferably, a department qualified to deal with cement burns. The patients contact with cement and caustic alkalis needs to be mentioned to the hospital staff.

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2.2.3 AVOIDANCE Protective waterproof (the latter word being commonly omitted in safety guidance) clothing should always be worn. If operatives have to kneel on fresh cement then special knee covers or string-held cut-outs of car tyres should be used. Any cement ingress behind these should be treated as in section 2.2.2. 2.3 PUMPING GROUT Typical uses of grout pumps are for operations such as filling the annuli between prestressing post-tensioning strands/wires and the duct tubes, and for filling gaps under large machine baseplates. It was in the former application that an operative suffered injury to an eye that nearly resulted in blindness of that eye. A blockage occurred in the tube line to the prestressed unit, and a coupling was loosened to open up the tube. Admittedly the person concerned should have been wearing eye protection, but he assumed that because the machine had been turned into the recirculation mode, pressure in the feed line had been relieved. He did not appreciate that, with the particular machine in use, the pressure had not been taken off the feed line. The pump supplier, when advised of this mishap, informed the project manager that there was a third position for the control tap. In addition to the 12 oclock recirculation and the 3 oclock line pressure positions, there was another one between 1 and 2 oclock that took the pressure off the feed line. It was admitted by the pump supplier that this omission in the instructions for use was an error, and that it would be rectified. Figure 2.1 shows a simple schematic outline of the system.

Fig. 2.1 Grout pump system (not to scale).

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2.3.1 IDENTIFICATION This potential problem can be identified as non-existent or inadequate suppliers guidance on how to deal with blockages in the system. 2.3.2 REMEDIAL Ask the supplier for written instructions on how to deal with pressure line blockages. If a coupling in the pressure line has to be undone because of a blockage, and no instructions are available, run the pump with the tap in approximately the midway position between the recirculation and pressurising positions. Ensure that the operatives wear full eye and hand protection at all times, and that there is a convenient optical douche nearby. 2.3.3 AVOIDANCE Use grout pumps only where there are distinct instructions on how to relieve pressure in the feed line should a blockage occur. Wear only approved eye and hand protection, and ensure that there is a convenient optical douche station.

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