MONITORING AND
HANDLING HEALTH ISSUES
Doctor JUVÉ Valérie
JUNE 2017
Beryllium - june 2017
OVERVIEW OF THE PRESENTATION
A. Role of the occupational Doctor relating to beryllium
B. Working with beryllium in France
C. Effects on health with acute effect and chronic effect
D. The medical assessment
Beryllium - june 2017 | PAGE 2
ROLE OF THE OCCUPATIONAL DOCTOR RELATING
TO BERYLLIUM
• Ensure that the medical approach meets the requirements
of the French regulations : ArtL4622-3 French Labour Code
• Develop the medical follow up program for IO beryllium
workers
• Confirm initial medical suitability for each employee to work
with beryllium in IO
• Implement a program of regular medical follow up to
confirm ongoing suitability of IO beryllium workers
• Pre-visit evaluation of supplier beryllium facilities
• Post visit follow up evaluation/tests for worker/facilities
• Further develop the medical practices for IO Be workers
according to new findings/best practice
Beryllium - june 2017 | PAGE 3
WORKING WITH BERYLLIUM IN FRANCE
• Prevention against dangerous chemical substances :
• Article R 4412-1 to R4412-57 French Labour
• Circular DRT 12 05/24/2006
• Prevention of CMR (carcinogens, mutagens and toxic
for reproduction substances) :
• Article R4412-59 to 4412-93 of French Labour
• Circular DRT 12 05/24/2006
• Working areas with ventilation :
• Article R4222-1 to R4222-6 of French Labour
Beryllium - june 2017 | PAGE 4
WORKING WITH BERYLLIUM IN FRANCE
• Showers for workers :
• Article R 4228-8 of French Labour the employer
shall provide showers for Be workers
• Reinforce the Medical follow up :
• Article R.4624-18 of the French labour code
• Prohibited for Temporary workers :
• Article D4154-1 to D4154-4 and R4154-5 and
D.4154-6 of French Labour
• Prevention document for companies external to IO :
• Article R4512-7 of French Labour and order of
03/19/1993
Beryllium - june 2017 | PAGE 5
BERYLLIUM
Beryllium - june 2017 | PAGE 6
WORKING WITH BERYLLIUM IN FRANCE
According to the CLP Regulation 1272/2008
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H350i : cancer could occur by inhalation category 1B
H301 : toxic by ingestion
H315 : skin irritation
H317 : skin sensitization
H319 : huge eye irritation
H330 : death by inhalation
H335 : irritation for lungs
H372 : toxic trigger for organs for a chronic exposure
• Recommended exposure limit : 2 μg/m3 (TWA 8 hours)
Beryllium - june 2017 | PAGE 7
LIMITS ADOPTED BY IO FOR WORKING WITH
BERYLLIUM
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According to IO commitment based on the Preliminary
Safety Report (PRSR)
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PRSR = indicates the following occupational exposure limits
for beryllium adopted by the IO
•
limit for atmospheric contamination :
 0.01 μg/m3 (a threshold for which an increased health
risk for staff is possible)
 0.2 μg/m3 (a threshold for which specific dispositions
are imposed with regard to the inhalation of material)
Beryllium - june 2017 | PAGE 8
ACUTE BERYLLIUM DISEASE
•
Following inhalation of beryllium dust, the following
could occur:
• Nose, eyes and lung irritations with dry cough,
washing could resolve with removal of the exposure
• Pneumonitis with strong wheezing, cough, chest
pain, fever, tiredness, on X ray possible granulomas.
Could disappear in 3 months but fibrosis could occur,
resulting in possible death
Beryllium - june 2017 | PAGE 9
ACUTE BERYLLIUM DISEASE
• Skin irritation, necrosis possible
• An allergic skin disease could occur after a few weeks of
exposure
• Based on the following articles
• « beryllium and beryllium compounds.IARC monographs on
the Evaluation of Carcinogenic Risks to Humans », 1993,
vol 58
• « FALCY M. Beryllium and
compounds.EMC.intoxications.Book 16.002 B 10,2003,4p
Beryllium - june 2017 | PAGE 10
CHRONIC BDERYLLIUM DISEASE
• Chronic granulomatous disorder with skin signs and
kidney disorder could occur after a long exposure to
low levels of beryllium.
• Signs could appear very slowly,tiredness, weight loss.
• Cough,,dyspnea,cyanosis,heart symptoms.
• The result of the breath test could be correct or not
• X Ray with granulomas possible without any respiratory
symptoms
• Biopsie of lungs could show a fibrosis
Beryllium - june 2017 | PAGE 11
CHRONIC BERYLLIUM DISEASE
• Heart damage possible, pneumothorax, a heart failure
could occur
• Diagnostic possible with BeLPT test but not available
directly in France
• Kidney Gallstone possible
• Lung Cancer and fibrosis
• Based on the following articles
 « Beryllium and beryllium compounds.IARC
monographs on the Evaluation of Carcinogenic
Risks to humans 1993, vol 58
 « FALCY M Beryllium and
compounds.EMC.Intoxications.Book n° 16.002 B
10.2003
Beryllium - june 2017 | PAGE 12
THE MEDICAL ASSESSMENT FOR IO BE WORKERS
• The medical record is mandatory, it must be kept in
a secure area
• The medical exam is performed before the
beginning of the job according to the French Labour
code
• Specifically relating to beryllium :
• The skin assessment
• The result of the spirometry lung function test
• A detailed medical history questionnaire
completed by the employee and reviewed with the
doctor
Beryllium - june 2017 | PAGE 13
THE MEDICAL ASSESSMENT
• All documents and records of medical advice
• To write all information about jobs and processes
• Medical surveillance of workers exposed to
beryllium
• Surveillance information is used to determine jobs
and processes with higher risks
• Medical follow up on a yearly basis decided by the
occupational doctor of IO but not mandatory
according to the new El Khomri French law
Beryllium - june 2017 | PAGE 14
THE OTHER MEDICAL TESTS
• Additional tests to be considered for implementation
into the IO Be worker medical program
• X ray
• BeLPT : not perfect, false positive and false negative
results may occur but the best available tool to indentify
sensitization until a more reliable test is developed (not
available in France but possible in neighbouring EU
countries)
• In CEA : nose samples and urine tests are available at
the moment
Beryllium - june 2017 | PAGE 15
THE INITIAL QUESTIONNAIRE
• The employment now and in the past
• The exposure of chemical substances at work and at
home (nickel, wood dust, well fume …) daily, weekly
and monthly
• History of skin cancer, other cancer, chest problem,
allergies..
• Smoking
• Coughs
• Phlegm
• Wheezing
• Chest illness
• Noses and eyes
• General health, medication, pets at home ?
Beryllium - june 2017 | PAGE 16
THE REVIEW QUESTIONNAIRE SINCE THE LAST
MEDICAL TEST
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The employment : any injury ? any problem with PPE ?
Skin problem, skin cancer, allergies, chest problem
Smoking
Breathing
Noses and eyes
General health
Home : any pets
Current medication
Beryllium - june 2017 | PAGE 17
THE OCCUPATIONAL HEALTH STANDARD OF
PRACTICE
• Height, weight, BMI
• Blood Pressure and pulse
• Breath test initial and review compared with previous
breath test
• Skin : rashes, eruptions, blisters ..
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Vision
Hearing
Musculoskeletal
Vestibular function : balance, tremor
Urinalysis
ECG
Comments
Beryllium - june 2017 | PAGE 18
COMPENSATED OCCUPATIONAL DISEASE
According to the National Health Care table n°33 of the check
list of the compensated occupational disease.
Irritation eyes and skin : issue identified up to 5 days following
the end of the job
Pneumonitis with signs on the X ray : issue identified up to 30
days following the end of the job
Fibrosis : tiredness,lose weight ,heart failure, pneumothorax with
signs on the X ray : issue identified up to 25 years following the
end of the job
Beryllium - june 2017 | PAGE 19
good health
retire
start employment
CHRONIC BERYLLIUM DISEASE
(EPIDEMIOLOGY/RISK)
beryllium sensitization (allergy)
CBD
Beryllium - june 2017
| PAGE 20
CHRONIC BERYLLIUM DISEASE
(PATHOPHYSIOLOGY)
Beryllium - june 2017 | PAGE 21
THANKS FOR YOUR ATTENTION
| PAGE 22
Beryllium - june 2017
Commissariat à l’énergie atomique et aux énergies alternatives
Direction de l’Energie Nucléaire
Centre de Cadarache | 13115 Saint -Paul Lez Durance Cedex
Département des Services de Sécurité
T. +33 (0)4 42 25 24 71 | F. +33 (0)4 42 25 32 32 | [email protected]
Service de Santé au Travail
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