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Occupational Health & Hygiene Essay
Occupational Health & Hygiene Essay
 
Table of Contents

Introduction. 3
The Origins of the Disease/Condition. 3
Possible Mechanisms for Disease/Condition Development 5
Silicosis. 7
Lung Cancer. 9
COPD (Chronic Obstructive Pulmonary Disease) 9
Activities within the stonemasonary industry where respiratory disease/condition is likely to occur. 10
The burden of disease/condition in the UK.. 12
Any Appropriate Occupational Exposure Limits and Methods of Assessing Exposure. 14
A Strategy for the Measurement of Exposure to the ‘Trigger’ Substance(s) 15
A Strategy for the Prevention and Management of Respiratory Disease with Reference to Good Practice Guidance, including Health Surveillance. 15
Conclusion. 16
References. 17

 
  
Occupational Health & Hygiene
Respiratory Disease in Stonemasonary

Introduction

According to the NHS Lothian (2022), the rate of respiratory disease in stonemasonary in the UK (United Kingdom) over the last few years has continued to escalate despite valuable regulations and legislation being implemented effectively. Furthermore, McCleery (2020) shockingly reported that numerous authoritative research findings showed that nearly one in five stonemasons worldwide were diagnosed with a killer respiratory disease associated with stonemasonary in what has been regarded as the workers’ worst crisis since asbestos. McCleery (2020) further articulates that the cases of stonemasons contracting killer respiratory diseases associated with stonemasonary have continued to double annually, according to new credible figures. Hence, this shocking phenomenon has referred to these starling figures as the world’s worst industrial crisis after the previous infamous asbestos sage. This report will be addressed to an industry advisory committee on respiratory disease in stonemasonry. It will cover numerous issues in the report, including the origins of the disease/condition and possible mechanisms for disease/condition development. The report will also cover the activities within the stonemasonary industry where disease/condition is likely to occur, the burden of disease/condition in the UK, and discuss appropriate occupational exposure limits and methods of assessing exposure. The report will also discuss a strategy for the measurement of exposure to the ‘trigger’ substances and a strategy for the prevention and management of disease/condition with reference to good practice guidance, including health surveillance.
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The Origins of the Disease/Condition

In reference to HSE (2022), stonemasons can contract various respiratory diseases associated with stonemasonary, including COPD (chronic obstructive pulmonary disease), lung cancer, and the dreaded silicosis. It is also instructive to note that respiratory disease in stonemasonary does not only affect stonemasons but also affects employees working within the stone working industry, including safety and health consultants, machinery suppliers, safety representatives, and other workers. Occupational Health & Hygiene Essay Most importantly, it is paramount for relevant authorities in the UK and other countries to continue developing and implementing stringent health and workers’ safety regulations and legislation to drastically reduce these respiratory diseases associated with stonemasonary and save lives. HSE (2022) further stipulates that employees in stonemasonary responsible for processing stone are at higher risks of developing occupational lung diseases resulting from their unfortunate activities of breathing in dangerous stone dust. Notably, these employees are at increased risk when breathing in stone dust containing RCS (respirable crystalline silica). HSE (2022) notes that these occupational lung diseases include COPD, lung cancer, and silicosis.
On the same note, Rosental (2017) states that silicosis can worsen in a stonemasonary employee even after its exposure has been eliminated or stopped. According to recent authoritative research findings, silicosis can eventually cause severe breath shortness, leading to challenges in walking even short distances an affected stonemasonary employee. It is instructive to note that silicosis is an irreversible and severe lung disease that can lead to early death and permanent disability. Research has also shown that there is an increased lung cancer risk in employees that have been diagnosed with silicosis.
In particular, credible research findings have confirmed that the origins of the respiratory disease in stonemasonary primarily originate from inhaling or breathing in RCS (respirable crystalline silica) dust (Barber et al., 2018). Notably, it is imperative to note that RCS is found in most products and materials, including concrete, tiles, bricks, clays, sands, and rocks. Subsequently, when these materials and products are worked on through grounding, carving, sanding, and cutting, dust is created into fine particles, which can eventually be breathed in or inhaled into a person’s lungs. Hence, research has confirmed that individuals are at higher risk of contracting and developing silicosis when exposed to RCS (Breathe Freely Organisation, 2021). Furthermore, silicosis heightens the risks of further contracting other lung infections and lung cancer and leads to breathing challenges. Nonetheless, it is worth noting that silicosis primarily develops after numerous years of RCS exposure, and excessive-high exposures over time can lead to acute silicosis and death. Prolonged and heavy RCS exposure leading to silicosis development can eventually cause lung cancer. RCS exposure can also lead to COPD, including emphysema and chronic bronchitis (Barber et al., 2018).

Possible Mechanisms for Disease/Condition Development

In particular, employees working in stonemasonary can suffer various respiratory diseases associated with breathing in or inhaling stone dust containing RCS or silica dust. It is instructive to note that the possible mechanisms for disease/condition development depend on the amount of silica dust or stone dust containing RCS and the level of exposure (Breathe Freely Organisation, 2021). Hence, the possible mechanisms for disease/condition development depend on numerous factors, including the workshop’s organisation, housekeeping arrangements, and dusty activity segregation. Other factors include the employees’ respiratory protective equipment and mask effectiveness, the duration of working with a particular tool, whether the utilised tool is hand-held or powered, and the type of tool being utilised. The other factor is the kind of stone an employee works on, including artificial/engineered and natural stone (Breathe Freely Organisation, 2021).
On the other hand, NSE (2022) notes that stone dust or silica dust comprises a dust particle mixture of various sizes, which can be inhaled or breathed in through the mouth and nose popularly known as inhalable dust.’ It is paramount to note that this ‘inhalable dust’ is primarily below or less than 100 microns (µm) in diameter (Feary, Suojalehto, & Cullinan, 2020). On the contrary, ‘inhalable dust’ that is small enough in particle size and can penetrate deeply into a person’s lungs is referred to as ‘respirable dust,’ and it is mainly less than or below 10 microns (µm) in diameter as portrayed in the illustration below (Figure 1):
(The NSE, 2022)
In particular, although inhalable dust can lead to irritation of the throat, nose, and eyes, the fine respirable dust particles have proved to be the fundamental cause of various severe long-term health issues and respiratory diseases in stonemasonary. Fine respirable dust, unlike inhalable dust, cannot be seen commonly when airborne with an individual’s naked eye, although it becomes visible when utilising a dust lamp (Donaldson et al., 2017). Moreover, when a particular stone is being processed and comprised of crystalline silica, whose common type is mainly quartz, there is a high possibility that the airborne stone dust being inhaled will contain RCS. Numerous research studies by reputable scholars have shown that RCS can potentially cause severe lung conditions, such as COPD, lung cancer, and silicosis. Subsequently, various stone types have also been found to contain different crystalline silica levels (Barber et al., 2018a).
Research has also shown that despite the different health effects associated with stone dust inhalation, other health effects are linked to stone working, including musculoskeletal disorders, hand-arm vibration syndrome, hearing damage, and dermatitis (Feary, Suojalehto, & Cullinan, 2020). Musculoskeletal disorders are primarily derived from manually handling stones, while hand-arm vibration syndrome is derived from working with different power-hand tools, especially hammers and stone chisels. Hearing damage is derived from the high noise levels from utilising power tools, whereas dermatitis is derived from stone dust since it can be abrasive and dries when it attaches to the skin, leading to a dermatitis health condition (Barber et al., 2018a).
On the same note, the possible mechanisms for respiratory disease in stonemasonary development also depend on exposure to stone dust or silica dust containing RSC, which eventually leads to various respiratory diseases, as discussed below:

Silicosis

According to Segelov Taylor Lawyers (2020), silicosis is an incurable, aggressive, and progressive lung disease belonging to a lung disorders group known as pneumoconiosis. The lung disease is characterised by the formation of fibrous scar tissue and nodules (lumps) in the lungs. Silicosis is also regarded as the most ancient common occupational lung disease in stonemasonary caused by extreme exposure to silica particle inhalation, especially those from quartz in the sand, rocks, and other similar substances. Thus, silicosis is essentially an aggressive fibrotic lung disease produced by building up and inhaling stone dust containing RCS in the lungs. It is instructive to note that many construction materials in stonemasonary contain silica, including granite, sandstone, tiles, bricks, and concrete. Thus, when these materials are worked with, crushed, cut, and drilled, tiny silica dust particles containing RCS are eventually inhaled or breathed in by employees in stonemasonry, causing silicosis (Barber et al., 2018a). Figure 2 below is an illustration comparing chest x-rays portraying damaged lungs affected by silicosis and undamaged lungs:
(The NSE, 2022)
Further, different types of silicosis exist depending on the duration and level of stone dust exposure, including acute silicosis, accelerated silicosis, complicated silicosis, and chronic silicosis. In particular, acute silicosis mainly develops within 6 months to 2 years of intensive silica dust exposure. Patients diagnosed with acute silicosis constantly experience shortness of breath, significantly lose body weight, and are at higher risk of contracting Tuberculosis (TB). Accelerated silicosis, according to research findings, mostly appears after 5 to 10 years of intensive silica dust exposure. Patients diagnosed with accelerated silicosis have various symptoms, including extensive fibrosis (fibrous tissue) formation in the lungs, excessive weight loss, and noticeable breath shortness. Moreover, such patients also mainly develop other autoimmune disorders and rheumatoid arthritis (Donaldson et al., 2017). On the other hand, complicated silicosis mostly appears after 10 to 15 years of intense silica exposure. Patients diagnosed with complicated silicosis have symptoms similar to those with accelerated silicosis and are at higher risk of developing TB. Chronic silicosis mainly develops after 15 years or more of intense silica dust exposure, causing only mild lung functioning impairment. Subsequently, it is paramount to note that chronic silicosis can progress or develop into more advanced types, which have been proven to be life-threatening (Barber et al., 2018a).

Lung Cancer

In principle, research has shown that RCS exposure is linked to lung cancer development due to intense silica dust exposure. It is instructive to note that lung cancer is a severe lung disease with different symptoms, including persistent breathlessness, coughing up blood, and persistent cough. Lung cancer has also been proven to substantially shorten life expectancy (Donaldson et al., 2017). Moreover, research has also shown that repeated, long-term silica dust exposure can cause lung cancer, although a single, severe exposure to this particular hazardous agent could seriously damage the lungs. Subsequently, research has further shown that many employees in stonemasonary are smokers, and smoking can accelerate the severity and risk of contracting lung cancer among them (The HSE, 2022c).

COPD (Chronic Obstructive Pulmonary Disease)

In particular, COPD (Chronic Obstructive Pulmonary Disease) is a terminology that entails emphysema and chronic bronchitis, as well as the world’s third leading cause of death, as noted by the WHO (2022). The WHO (2022) also notes that occupational silica dust exposure is among the key risk factors associated with COPD and the leading causes of mortality and morbidity in developing and industrialised countries, such as the UK. According to the NSE (2022), COPD is a potentially severe, progressive breathing problem associated with RCS exposure. Continuous exposure to RCS can escalate COPD to advanced stages, leading to frequent chest infections, persistent coughs, and severe breathlessness.
On the other hand, credible research findings have shown that stone dust inhalation containing RCS is the biggest health risk, although other minerals and dust particles found in stone dust can also lead to breathing problems and lung damage. It is also instructive to note that exposure to RCS amounts of 0.05 mg/m3 over a working lifetime of nearly 45 years can portray a 5% risk of contracting silicosis, as noted by the NSE (2022). Thus, it is essential that adequate, accurate, and appropriate control measures are maintained, checked, and selected by competent individuals to drastically eradicated silicosis and significantly reduce the inhalation amount of silica dust for people working in stonemasonary. Research has also shown that regular silica dust exposure in small RCS amounts can eventually put employees in stonemasonary at high risk of lung disease (Koh & Gan, 2022).

Activities within the stonemasonary industry where respiratory disease/condition is likely to occur

In practice, the activities within the stonemasonary industry where respiratory disease/condition is likely to occur include working with materials containing RCS, such as concrete, tiles, bricks, clays, sands, marble, chalk or limestone, basalt, and rocks. Other materials include dolerite, ironstone, slate, granite, China stone, shale, mortar, quartzite, and sandstone (The HSE, 2022c). Notably, silica dust is normally created when these materials are polished or grounded, carved, sanded, chiseled, or cut, and this silica dust is eventually inhaled into a person’s lungs, causing respiratory disease in the stonemasonary industry. Moreover, RCS exposure in the stonemasonary industry can also occur in other activities, including when working with hammers, stone chisels, and manually handling stones. According to Rosental (2017), some occupations with RCS exposure include industries utilising silica flour when manufacturing goods, construction (when breaking or cutting brick or concrete), stonemasonary, potteries, foundries, slate works, and quarrying.
On the other hand, the NSE (2022) articulates that RCS exposure also depends on the type of stone being utilised in the stonemasonary activities, such as various kinds of natural stone, asbestiform minerals, artificial stones, and engineered stones. Other kinds of stone that can lead to RCS exposure include agglomerated stone, sintered and cast stone, and terrazzo. In reference to Feary, Suojalehto, & Cullinan (2020), stonemasonary activities using these different kinds of stone can lead to varying rates of RCS exposure, whereby the natural stone and other mineral-based materials contain different crystalline silica content. The table (Table 1) below portrays the various kinds of mineral-based materials and natural stones, as well as the crystalline content contained in each of them:
(The NSE, 2022)
On the same note, the NSE (2022) expounds that asbestiform minerals have been recognised to contain some soapstone (serpentinite) and white marble, although further studies should be conducted to establish asbestos fibres and the amounts. Subsequently, artificial stone has been found to contain crystalline silica content since it’s a synthetic product derived from different materials, such as stone pieces (natural aggregates), sand, and cement bound together utilising either resins (chemical means) or physical means (for example, pressure and heat). Engineered stones also contain crystalline silica because they typically comprise nearly 95% quartz or marble (crushed stone pieces), low colourants and additives levels, and 5% resin (Feary, Suojalehto, & Cullinan, 2020).
On the other hand, sintered and cast stone contains nearly 5-25% crystalline silica content since it is made by applying temperature and pressure to mineral mixtures or crushed stone, including porcelain, granite minerals, feldspar, sand, clay, and aluminosilicates), although resin binder is not utilised. Notably, sintered stone entails porcelain and ceramic. Terrazzo has also been found to contain crystalline silica since it is made by embedding crushed stone and pouring concrete. Additionally, terrazzo is substantially polished on floors, producing significant crystalline silica content dust (Bloch, Brack, & Ulrich, 2022).

The burden of disease/condition in the UK

Most importantly, respiratory disease in stonemasonary applies a significant burden of disease/condition in the UK because the UK government spends substantial amounts of taxpayers’ money to tackle the various diseases associated with the disease. In particular, the UK government spends colossal amounts of money to tackle the different diseases associated with respiratory disease in stonemasonary, including silicosis, lung cancer, COPD, and other health risk conditions. Salciccioli et al. (2018) note that respiratory diseases in the UK pose a huge burden across its health systems. The UK has been previously regarded as an outliner due to its higher morbidity and mortality.
In reference to the Asthma and Lung UK Company (2022) report, the cost of respiratory disease in the United Kingdom is shockingly a staggering £11 billion annually. Hence, this amounts to a huge burden of respiratory to the UK’s economy, patients, and the NHS. The Asthma and Lung UK Company (2022) report further notes that from this staggering £11 billion annual cost, £9.9 billion directly falls on patients and the NHS in private costs, whereas £1.2 billion falls on UK’s wider economy, especially through lost work days. The report also states that respiratory disease in the UK is the 4th mostly costly disease, after heart disease, musculoskeletal diseases, and mental health conditions. Subsequently, COPD is among the costliest respiratory diseases costing £1.9 billion annually. The report also stipulates that respiratory disease in the UK is solely responsible for a substantial share of premature death and serious morbidity among its population (The Asthma and Lung UK Company, 2022).
Furthermore, the British Lung Foundation (2017) expounded that the estimated indirect and direct costs of all respiratory diseases in the UK exceeded £11.1 billion in its 2017 findings. The findings showed that when intangible costs linked to excess morbidity and mortality were included, these costs rose to £165 billion. Moreover, the NHS (2022) states that respiratory disease in the UK affects 1 in 5 individuals and is England’s third largest cause of death.
Moreover, the NHS (2022) also articulates that respiratory disease hospital admissions have dramatically increased over the previous 7 years at 3 times the total number of admissions. In addition, the NHS (2022) highlights that the annual economic burden of COPD in the UK on the NHS is estimated to be £1.9 billion annually. Further, all lung conditions in totality when lung cancer in the UK is included directly cost the organisation an estimated £11 billion annually (The NHS, 2022). Hence, it is noticeable that respiratory disease in the UK poses a substantial disease burden to the UK’s economy, patients, and the NHS.

Any Appropriate Occupational Exposure Limits and Methods of Assessing Exposure

In principle, different appropriate occupational exposure limits and methods of assessing exposure have already been developed and implemented. However, research has shown that despite implementing these stringent appropriate occupational exposure limits and methods of assessing exposure being enforced, numerous firms within the stonemasonary industry continue to circumvent or ignore them blatantly, leading to respiratory disease among their employees. Notably, the NSE (2022) specifies that employers in the stonemasonary industry have a fundamental legal obligation to comply with appropriate occupational exposure limits and methods of assessing exposure stipulated under the COSHH (Control of Substances Hazardous to Health Regulations 2002) (as amended). Subsequently, employers must comply with COSHH Regulation 7(7) by applying Schedule 2A and ensuring that exposure is not above the WEL. Ideally, the NSE (2022b) notes that the RCS exposure in the UK has a WEL (workplace exposure limit) of 0.1 mg/m3, primarily portrayed as an 8-hour TWA (time-weighted average). Further, the NSE (2022b) stipulates that RCS exposure is subject to the COSHH Regulations 2002.  
On the same note, the NSE (2022) outlines those individual substances, such as the RCS containing their own established WELs. Employers should comply with the limits highlighted in the EH40/2005 publication, which should never be exceeded. The control measures employers require are highlighted under COSHH Regulation 7(1), COSHH Schedule 2A, the COSHH Approved Code of Practice, the HSE COSHH Essentials Guidance Sheets, and the CIS (Construction Information Sheets). Other relevant guidance for employers regarding controlling stone dust exposure, including RCS, entail the IOSH (Institute of Occupational Safety and Health), the BOHS (British Occupational Hygiene Society), the NEPSI (European Network on Silica), and the EU SLIC (Senior Labour Inspectorate Committee) Guidance (The NSE, 2022).

A Strategy for the Measurement of Exposure to the ‘Trigger’ Substance(s)

In practice, a strategy for measuring exposure to the ‘trigger’ substance known as RCS includes employers in the stonemasonary industry implementing what is known as the Hierarchy of control strategy. It is instructive to note that this Hierarchy of Control strategy involves implementing various key elements (Baldwin et al., 2019). These elements include elimination, engineering controls, segregation, organisational controls, PPE (personal protective equipment), a combination of controls, and maintaining controls, including the LEV systems. Most importantly, this strategy for measuring exposure to the ‘trigger’ substance complies with the stipulated COSHH Approved Code of Practice L5 (The State of Queensland, 2019).

A Strategy for the Prevention and Management of Respiratory Disease with Reference to Good Practice Guidance, including Health Surveillance

In principle, a strategy for the prevention and management of respiratory disease with reference to good practice guidance, including health surveillance, entails drastically reducing the risks to health by effectively controlling fumes and dust (Bloch, Brack, & Ulrich, 2022). Ideally, effective control will be attained by combining different control prevention and management systems, including process changes, providing employees with adequate high-quality RPE (respiratory protection equipment), and installing a proper working LEV (local exhaust ventilation) system for fume and dust extraction Occupational Health & Hygiene Essay. Moreover, this strategy also includes providing water suppression with sufficient flow of water to the tools utilised when working (HSE, 2022a).
 

Conclusion

In summation, this report has been addressed to an industry advisory committee on respiratory disease in stonemasonry and covered many issues, including the origins of the disease/condition and possible mechanisms for disease/condition development. The report has also covered the activities within the stonemasonary industry where disease/condition is likely to occur, the burden of disease/condition in the UK, and discussed appropriate occupational exposure limits and methods of assessing exposure. The report has also discussed a strategy for the measurement of exposure to the ‘trigger’ substances and a strategy for the prevention and management of disease/condition with reference to good practice guidance, including health surveillance.

References

Baldwin, P. E., Yates, T., Beattie, H., & Keen, C. (2019). Exposure to Respirable Crystalline Silica in the GB Brick Manufacturing and Stone Working Industries. Annals of Work Experiences and Health 63(2):1-13. DOI:10.1093/annweh/wxy103. https://www.researchgate.net/publication/331037161_Exposure_to_Respirable_Crystalline_Silica_in_the_GB_Brick_Manufacturing_and_Stone_Working_Industries
Barber, C. M., Fishwick, D., Carder, M., & Tongeren, M. (2018). Epidemiology of Silicosis: Reports from the SWORD scheme in the UK from 1996 to 2017. Occupational and Environmental Medicine 76(1). http://dx.doi.org/10.1136/oemed-2018-105337 Occupational Health & Hygiene Essay. https://www.researchgate.net/publication/328863437_Epidemiology_of_silicosis_Reports_from_the_SWORD_scheme_in_the_UK_from_1996_to_2017
Barber, C. M., Fishwick, D., Seed, M. J., & Carder, M. (2018a). Artificial Stone-Associated Silicosis in the UK. Occupational and Environmental Medicine 75(7). DOI:10.1136/oemed-2018-105028. https://www.researchgate.net/publication/323198277_Artificial_stone-associated_silicosis_in_the_UK
Bloch, K. E., Brack, T., & Ulrich, S. (2022). Self-Assessment in Respiratory Medicine. London: European Respiratory Medicine.
Breathe Freely Organisation. (2021). Stonemason. https://breathe-freely-staging.wabbajack.co.uk/wp-content/uploads/2021/07/stonemason_fact_sheet.pdf
British Lung Foundation. (2017). Estimating the Economic Burden of Respiratory Illness in the UK. http://allcatsrgrey.org.uk/wp/download/respiratory_diseases/PC-1601_-_Economic_burden_report_FINAL_8cdaba2a-589a-4a49-bd14-f45d66167795.pdf
Donaldson, K., Wallace, W., Henry, C., & Seaton, A. (2017). Death in the New Town: Edinburgh’s hidden story of stonemason’s silicosis. Journal of the Royal College of Physicians of Edinburgh. https://www.rcpe.ac.uk/sites/default/files/jrcpe_47_4_donaldson.pdf
Feary, J., Suojalehto, H., & Cullinan, P. (2020). Occupational and Environmental Lung Disease. London: European Respiratory Society. Occupational Health & Hygiene Essay
Koh, D. S. Q. & Gan, W. H. (2022). Textbook of Occupational Medicine Practice (Fifth Edition). Cambridge: World Scientific.
McCleery, A. (2020). The Great Tradie Shame: One in Five Stonemasons have been diagnosed with a killer disease in the worst crisis for workers since asbestos. https://www.dailymail.co.uk/news/article-7904725/One-five-stonemasons-diagnosed-killer-disease-worst-worker-crisis-asbestos.html
Rosental, P. (2017). Silicosis: A World History. New York: JHU Press.
Salciccioli, J. D., Marshall, D. C., Shalhoub, J., Maruthappu, M., Carlo, G., & Chung, K. F. (2018). Respiratory disease mortality in the United Kingdom compared with EU15+ countries in 1985-2015: observational study. NIH National Library of Medicine. Doi: 10.1136/bmj.k4680. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259045/
Segelov Taylor Lawyers. (2020). Silicosis and Stonemasons. https://www.segelovtaylor.com.au/silicosis-and-stonemasons/
The Asthma and Lung UK Company. The Battle for Breath – The Economic Burden of Lung Disease. https://www.blf.org.uk/policy/economic-burden
The HSE. (2022). Controlling Exposure to Stone Dust. https://www.hse.gov.uk/pubns/priced/hsg201.pdf
The HSE. (2022a). Stoneworker. https://www.hse.gov.uk/lung-disease/stonemasonry.htm#:~:text=How%20to%20control,water%20suppression%20and%20process%20changes.
The HSE. (2022b). Silicosis. https://www.hse.gov.uk/lung-disease/silicosis.htm
The HSE. (2022c). Silica Dust. https://www.hse.gov.uk/stonemasonry/silica-dust.htm
The NHS Lothian. (2022). Stonemason Medicals. https://services.nhslothian.scot/occupationalhealthcommercial/Services/Pages/StonemasonMedicals.aspx
The NHS. (2022). Respiratory Disease. https://www.england.nhs.uk/ourwork/clinical-policy/respiratory-disease/
The State of Queensland. (2019). Code of Practice 2019. https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0013/32413/managing-respirable-crystalline-silica-dust-exposure-in-the-stone-benchtop-industry-code-of-practice-2019.pdf
The WHO. (2022). Chronic Obstructive Pulmonary Disease (COPD). https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd) Occupational Health & Hygiene Essay

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