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Asbestos: learning to live with the hidden killer

From doctors’ practices to hospitals, many of our healthcare institutions occupy buildings that are likely to contain asbestos. Connect asks what you can do to protect yourself and others.

Asbestos is the single greatest cause of work-related deaths in the UK, causing 4,000 deaths per year. The HSE reported that in 2007, 2,156 people died from mesothelioma – an asbestos-related cancer that can take 40 years to develop and Britain now has the world’s highest mesothelioma death rate. Although its use is now banned, asbestos is still present in many buildings, including many of our healthcare institutions.

“Asbestos is likely to be widespread in older buildings,” says Nigel Bryson, director of Bryson Consulting. “It’s difficult to identify any reliable estimates as to how much remains in buildings in current use, but generally speaking, as all forms of asbestos were banned in 1999, the HSE indicates that any building built in 2000 or after is unlikely to contain asbestos.”

A lethal legacy

You only have to look at last year’s press to see the legacy of asbestos among healthcare professionals. There’s the death of retired hospital maintenance worker John Swales, reported in the Lancashire Evening Telegraph in April. John had worked in several hospitals during the 1960s and had sometimes come home covered in asbestos dust. A post-mortem examination found a staggering eight million asbestos fibre particles in his lungs.

Writing in The Guardian last April, just a couple of months before he died, Doctor James Partridge said he believed his mesothelioma was caused by exposure to asbestos-lagged pipes in hospitals when he was a trainee in the 1950s.

Then there’s the Nursing Times report about the rising number of nurses now dying from mesothelioma, after being exposed to asbestos early in their careers.

The stories just keep coming, and each one underlines the fact that asbestos has been widely used in buildings such as hospitals and clinics. As Dr Partridge wrote, nobody knew about the harmful effects of exposure to asbestos in the 1950s and 1960s, and many people who’ve worked in the healthcare industry are now suffering from the results of exposure to asbestos decades ago.

For all the tragedies that are being lived out, at least we now know about asbestos risk. Breathing in asbestos fibres can cause potentially fatal conditions such as asbestosis, lung cancer and mesothelioma. These diseases tend to be significantly advanced by the time they’re diagnosed and in the case of mesothelioma, may leave patients with only a few months to live.

But we can’t just get rid of all the asbestos in our hospitals and other public buildings. If we don’t want asbestos to kill people, we have to learn how to live with it – that is, to manage it so that it doesn’t pose a risk to people’s health.

A legal duty

The Control of Asbestos Regulations 2006 brings together the previous requirements on asbestos use and bans the importation, supply and use of all forms of asbestos. Crocidolite (blue asbestos) and amosite (brown asbestos) have been banned since 1985, while chrysotile (white asbestos) has been banned since 1999. There’s also a ban on the second-hand use of asbestos products, such as asbestos cement sheets and tiles. But there’s still a lot of asbestos in existing buildings, and for non-domestic premises such as healthcare facilities, the Asbestos Regulations specify a "duty to manage asbestos".

It’s difficult to evaluate how well healthcare businesses are managing asbestos. However, Bryson points out that the HSE health and safety plan for the health sector includes actions like "ensuring consistency in dealing with asbestos duty to manage issues" and "proactively seeking examples of poor asbestos surveying work with a view to bringing those that manifestly fail in their duties to account". This suggests that there may be a need for more consistency in asbestos management across the healthcare sector.

“The issues facing healthcare institutions are likely to be identifying whether they have asbestos in the building; the quality of the management plan; maintaining an effective asbestos register; and training workers to understand what they need to know about asbestos,” says Bryson. “For example, in GP surgeries housed in old buildings, they might not realise that asbestos could be an issue and what plans are needed.”

So, how can you make sure you know about all the asbestos in your buildings – and once you know about it, how should you manage it?

Know your enemy

In order to manage asbestos effectively, it’s important to understand it. In the past, blue, brown and white asbestos have all been used extensively in building, including insulation, ceiling tiles, fire-proofing materials, guttering and wall panels. While blue and brown asbestos have been acknowledged as the most hazardous types, white asbestos is potentially harmful in its own right, and it’s often mixed with other types.

What you can do

“Duty holders in all buildings should have a plan for managing asbestos, including emergencies where asbestos contamination may occur,” says Bryson.

The Methods for the Determination of Hazardous Substances series (MDHS 100) – the asbestos surveyor’s guidance – was updated in December 2009. Connect published an article in October last year aimed at providing guidance for health and safety professionals on surveys, sampling and the assessment of asbestos-containing material.

A brighter future

The slow development and late diagnosis of many asbestos-related diseases means that we’ve not yet seen the worst of its effects on those exposed decades ago. We may know more about asbestos risk now, but this is no time to become complacent. Only by learning to live with asbestos – by constantly monitoring and managing it – can we make sure that today’s healthcare staff and contractors don’t become the asbestos victims of tomorrow.