For every construction worker fatally injured at work, Safe Work Australias estimate that more than eight will die from an occupational illness or disease. While those statistics highlight the importance of focussing on health, all too often, health has played a secondary role to its better-understood safety counterpart.
Health in tunnelling and construction can be taken to mean many things, from fit for duty medical assessments, to drug and alcohol testing, and wellbeing programs. While these elements all form an important part of any major project’s overall health and safety program, none of them prevent illness and disease from occurring in the first place, or from getting worse.
Tunnel construction workers are known to have a high risk of ill-health due to the nature of their work. This includes higher prevalence of diseases such as silicosis, chronic obstructive pulmonary disease, other adverse respiratory symptoms, asthma, lung function decline double the rate of heavy smokers, and an increased risk of lung cancer.
In Australia, more than two-thirds of all tunnelling happens in Sydney. Sitting on top of a bedrock of Hawkesbury sandstone below a layer of shale, all of Sydney’s tunnels are constructed through rock that contains high proportions of quartz (ranging from 20 per cent to more than 75 per cent). Tunnelling through quartz-containing rock generates respirable crystalline silica, commonly known as silica dust. Over-exposure to silica dust is known to result in the development of an incurable and specific pneumoconiosis, known as silicosis, in addition to lung cancer and renal disease. Tunnel construction represents a key part of building Australia’s necessary infrastructure and services and is complemented by world-class feats of engineering. However, it is reasonable to expect that the delivery of such world class infrastructure will not be the cause of yet another epidemic of industrial disease in the future
The author is an occupational hygienist and is the manger for occupational health and hygiene at Ventia, currently supporting Sydney Metro, Australia’s largest public transport infrastructure project. She was awarded a Churchill Fellowship from the Winston Churchill Memorial Trust to investigate best practice to prevent illness and disease in tunnel construction workers. The fellowship took her across the globe to visit major tunnelling projects and research institutions in Norway, Switzerland, the UK, and USA.
Australia is currently experiencing a surge in tunnel construction projects across the country. This is an opportune time to not only learn from its past but to look outwards internationally to define a best-practice approach to prevent illness and disease in the thousands of Australians who will work to support these great projects. With projects that push boundaries and ask challenging questions, the aim of the Churchill Fellowship was to bring back knowledge for the benefit of Australian workers and the Australian tunnelling industry.
WHAT IS BEST PRACTICE?
One of the challenges to determine what best practice may be is knowing where to start. Using existing research eight elements were established as a framework to investigate best-practice approaches internationally.
The tunnelling projects visited on during the fellowship included some of the largest and most complex as well as several organisations, research institutions, and conferences including:
¦ Institute of Occupational Medicine, Edinburgh, UK
¦ Breathe Freely Campaign, BOHS, UK
¦ Loughbrough University, UK
¦ Thames Tideway, London, UK
¦ Park Health and Safety, London, UK
¦ High Speed Rail 2, London, UK
¦ Crossrail, London, UK
¦ World Tunnel Congress, Bergen, Norway
¦ Arna-Bergen Ulriken Railway, Bergen, Norway
¦ Norway Institute of Occupational Health, Oslo, Norway
¦ ETH Combustion-Generated Nanoparticles Conference, Zurich, Switzerland
¦ Gotthard Base Tunnel, Switzerland
¦ SUVA Occupational Medicine, Luzern, Switzerland
¦ Sanierungstunnel Belchen Tunnel, Switzerland
¦ National Institute of Occupational Health Centre for Disease Control, Pittsburgh, PA, USA
¦ American Industrial Hygiene Society, Falls Church, VA, USA
¦ Anacostia River Tunnel, Washington, D.C., USA
¦ Laborers Health and Safety Fund, Washington, D.C., USA
¦ SR-99 Alaskan Way Viaduct, Seattle, Washington, USA
WHAT WAS DISCOVERED
Leadership
Leadership at the highest levels of the client organisation was observed to be successful in driving a focus on ill health prevention during design, as part of the project culture, and through the supply chain, subsequently creating more stakeholders that also took ownership and in turn, their own leadership on this issue. Regulatory involvement, and enforcement was observed to create a positive impact in the amount of attention, awareness, and therefore leadership.
Demonstrated leadership in occupational health and hygiene was found to be an essential part of an effective and sustainable program that reduced ill health. It was more than the traditional focus on fitness for duty, rehabilitation, or drug and alcohol testing, but on the prevention of exposure leading to occupational illness or disease.
Engagement and collaboration
Engagement and collaboration involving many stakeholders were observed to create a positive culture surrounding heath protection. Collaboration across multiple tunnelling projects in the UK has resulted in sharing of knowledge whereby good practices have been adopted earlier than they may have otherwise. Initiatives to collaborate within individual projects were also observed to be beneficial, including the use of occupational health forums, and incentivising contractors for collaborating through contractual arrangements.
Industry groups in this sector internationally have both raised awareness and driven a best practice approach. In addition, collaboration with research institutions was common place in the UK and Norway. Engagement with research partners has enabled a greater understanding of the magnitude of the issue leading to greater awareness and robust control measures being implemented.
International tunnelling projects understand and utilise the value of independent research to track the effectiveness of current practices on the magnitude of exposure and the extent of illness and disease.
Training and awareness
Moving away from the traditional classroom-style, PowerPoint filled with dot points of information or online learning, and towards an immersive, multi-media experience of behavioural based learning, was a theme well demonstrated in the UK and the USA.
Specifically, induction courses that target human behaviour as the root cause of health and safety incidents were observed to leave participants with a lasting memory of how it felt to be in each situation, and how those lessons were applied.
The use of simulations, such as LUSKInS developed by Loughborough University (interactive gloves), or the use of video exposure monitoring through a Helmet-CAM system from NIOSH, are interactive approaches to training that represent an improvement over traditional methods.
Project-wide awareness campaigns that target silica and dust control have been effective at both raising awareness, but also demonstrating its importance. The use of powerful and realistic videos, such as the Crossrail 999 Campaign provide depth to a campaign, highlighting that they need to be more than a simple poster approach.
Standards
International health and safety regulatory authorities have worked to produce clear information to assist employers to assess, document, communicate, and control health risks. They provide guidance on training and instruction, how hazards can be monitored, and all have a requirement for health surveillance. At a basic level, there is a requirement to notify a central agency of a diagnosis of an occupational disease such as silicosis in each country, which is an area currently lacking in Australia. The amount of focus and information published internationally on the assessment and control of health hazards such as silica, provides further guidance, clarity, and context on what is expected of employers and employees when controlling exposure.
All major tunnelling projects internationally have either mandated targeted contractual requirements or referred to standards that are more stringent than those commonly used in Australia. Contractual requirements that pertain to health were outlined and included in tender documentation.
Key elements that were identified in such contractual requirements included specifications for i) competency; ii) health in design approaches; iii) transparency in data sharing; iv) standardised health risk assessment and control frameworks; v) training requirements; vi) benchmarking health performance; vii) collaboration on research; viii) health surveillance; and ix) wellbeing.
Health in design
Addressing the element of health as design criteria internationally has resulted in higher-order controls being applied at time of design. Internationally, contractors are required to provide evidence on how they have engaged with specialists such as occupational hygienists, ergonomists, and medical practitioners during the design process. If health risks are not eliminated at the design stage, then there is a requirement to demonstrate how health risks will be mitigated, what controls will be applied, and how they will be applied for the project life-cycle from construction through to the operation and maintenance phase. This approach highlighted the cost of ill-health prevention measures and enabled the inclusion of health in the cost-benefit analysis process when selecting appropriate control measures.
Program management
The use of an initial health risk assessment to drive decisions regarding controls, monitoring, and health surveillance, is a standard practice in the UK. Some countries and projects have further simplified their approach through mandating health surveillance for all tunnel workers, regardless of the assessed risk. International best practice in health surveillance includes the use of occupational physicians complimented by competent health clinical services, a standardised approach for what is deemed fit for duty and the centralised collection of medical data to enable trends to be reviewed to inform future interventions and policy.
The use of benchmarking tools in the UK such as the Occuptational Health Maturity Matrix and the Health Impact Frequency Rate are standardised approaches to both measure compliance, but also, push towards best practice.
These tools enable a systematic and transparent understanding of the degree of compliance, leading to incremental improvements over time. They also were successful at raising awareness of the effectiveness of certain control measures applied to reduce health risks.
Targeted management
There were many new tools discovered that would enable the faster assessment of exposures to dusts, silica, and diesel particulate, which can also be used to provide greater clarity on areas of peak exposures. The use of the Helmet-CAM system from NIOSH in which video exposure monitoring is used, enables areas or sources of high exposures to be verified that may not otherwise have been apparent in the regularly changing environment of tunnel construction.
The use of a field-based monitoring approach to silica was observed to enable quicker action to be taken to reduce high exposures, and the use of real-time DPM monitors would provide greater clarity on the effectiveness of ventilation and other controls in many areas of a tunnel system.
Other initiatives such as the use of canopy air curtains, enclosed cabin filtration systems, dust suppression, and virtual training approaches, all demonstrated the strong link between the tunnelling and mining sectors.
The development of best practice standards for the control of silica dust, as they related to each project, provided a clear framework for contractors and subcontractors to follow when planning work activities. Some of the best guides were those that involved collaboration with the client, designers, and contractors. There were many areas observed that would be considered “best practice” and over and above what is considered “routine” in Australian tunnelling. Some of these included conveyor wash boxes for conveyor belts; specific types of nozzles for dust control to maximise effectiveness; the use of atomised spray rings; the use of Diesel Particulate Filters along with automated alarming systems that alert the operator when changeover is required through the installation of real-time backpressure alarm systems; the use of covers placed over muddy work boots to prevent tracking of silica-laden dusts into work spaces; and a prohibition of disposable respiratory protection for routine use, therefore increasing reliance on effective and efficient engineering controls.
Sustainability Establishing a platform where knowledge is shared early in the project has enabled good practice guidance to be developed and ensured that “good” information was not lost when team members left the project. Each major tunnelling project in the UK has or is in the process of developing, a Legacy Learning website where such information is shared. The prevention of chronic health risks relies on a sustainable approach over time. Performance measures that drive sustainable approaches are commonplace in the UK.
Frameworks such as the Occupational Health Maturity Matrix provide a benchmarking tool that drives such sustainable change.
CONCLUSION
Overall, it is concluded that the existing health and safety framework that the tunnelling industry operates within, requires improvement to protect the health of tunnel workers. The current system has several limitations and would benefit from:
¦ Greater widespread leadership on health from clients commissioning tunnelling projects, health and safety
regulatory authorities, and contractors performing such work;
¦ Greater considerations of health in design;
¦ A centralised and standardised health surveillance system complimented by disease notification requirements;
¦ A standardised health risk assessment framework leading to exposure monitoring and higher take-up of health surveillance;
¦ Increased client governance and regulatory enforcement of compliance requirements;
¦ Engagement with research partners;
¦ An increase in training and awareness leading to greater knowledge and skills to effectively manage health risks; and
¦ An increased focus on prevention of exposure to health hazards leading to illness and disease.
In addition, the creation of a common framework for the collection of exposure monitoring and disease prevalence data would enable lessons that could be learned and then shared as collective knowledge across the tunnelling industry. There were many recommendations made to improve the state of the tunnelling industry outlined in the author’s report which has now been published and available online: https://www. churchilltrust.com.au/fellows/detail/4105/Kate+Cole
WHAT’S NEXT
The author is managing the Occupational Health and Hygiene Program on Sydney Metro. Being the largest public transport infrastructure project in the country, the important issue of preventing work-related illness and diseases in the thousands of workers who will contribute to its successful delivery, forms a key element in Sydney Metro’s Health and Safety Strategic Plan. It was the first Australian Government transport agency to develop a specific standard targeted at the reduction of occupational illness and disease in the workforce, with the project instilling a structured risk-based approach to health risk management. The program requires delivery partners to address health risks as part of design, and uses a structured approach of risk assessment, control, and review, to ultimately reduce reliance on lower-level control measures such as personal protective equipment.
Since returning from the fellowship, the author has worked in collaboration with the state health and safety regulator on a specific project to tackle awareness of silica exposure in the industry, as well as working with research institution, RMIT, which has been engaged to undertake a series of independent research project across Sydney Metro, with one specifically addressing the health of the workforce.
What was made evident from the fellowship was that advocating for health at the most senior level drives successful outcomes at the site level, where it is most needed. Compliance with minimum legal requirements are not enough, but rather government clients need to drive these outcomes. Sydney Metro is currently driving a new wave of industry transformation through raising the bar and setting new standards in health during delivery of these mega tunnelling projects.
The information obtained throughout this fellowship is currently being applied and shared, so that collectively, Australia will start pushing the boundaries of good practice to its ultimate goal of best practice.
