 This video is designed to increase your knowledge about the disease silicosis, to alert you to the potential health hazards when working with silica, and to discuss ways to reduce exposure to silica dust. Silicosis is a form of pneumoconiosis, which means dust in the lungs, or in this case, silica dust in the lungs. This video will help you recognize the hazards of working with silica. It will also explain how your lungs and respiratory system are affected by exposure to silica dust. And it will also describe the different types of silicosis, and methods of detection and prevention. Dr. I've been hearing in our training classes about silicosis, but I'm not exactly sure what it is. Well, silicosis is a disease of the lungs caused by the continued breathing in of air containing silica. Silica is a hard, abrasive mineral. It comes in three forms, quartz, which is the most common, and crystallite and tritamite, which are not as common but are more toxic. Silica is found in all types of rock and in most metal and non-metal ores. Because soil is formed from the weathering of rock, most of the dirt covering the earth contains some silica. Now the form of silica and the amount of silica in the worksite or ore can vary. You should talk to your safety director or foreman. They can describe what's in your area because of your company's sampling program. It's important to know when silica is present in the materials you're working with, what silicosis is, and how to avoid getting it. I don't know much about the lungs, doctor, except I know you need them to breathe. Could you explain how they work and how the lungs are affected by dust? It'll be easier with an illustration. If you've got a few minutes, come with me to the training room. Well, you've really got a nice training room here, John, with some really good materials. In fact, here's a drawing that can show you what I'm talking about. This is a human respiratory system, your breathing system, that circulates oxygen throughout your body to allow it to work. As you inhale, the air travels down a tube called the trachea, or windpipe, into the bronchial tubes and into smaller ducts called bronchioles. It eventually reaches the end air spaces, tiny sacs which are functional parts of the lungs called alveoli. This is where the oxygen gets into our blood, and carbon dioxide, a waste product, is returned to our lungs to be exhaled. This is the most important function of our lungs, to get oxygen into our body and to get carbon dioxide out. Well, the human lung is quite a unique organ. Keep in mind, though, that anything that can significantly affect the exchange of oxygen and carbon dioxide can cause health problems for a person. I remember hearing in our training classes that the respiratory system cleans itself. How does it do that? That's a good question. It all begins in the nose, where we have nose hair, followed by cells and mucus lining the walls of the nasal passages. The nose hair filters out the largest particles, which are then removed when we blow our nose. As you get farther down in the respiratory system, another mechanism comes into play. It's called the mucociliary escalator. It works like a conveyor. The hair cells of the mucociliary escalator, which line the upper airways, along with the mucous, catch and trap large particles and then sweep them up and out, where you swallow them or spit them out. This is the lungs' first defense against bacteria or dust. What if the silica particles get by this first defense? If the silica particles are very small, what we call respirable dust, they can penetrate deep in the lung, but also deep inside the lung within the alveoli we find the next defense mechanism. These are called macrophage cells. They operate just like the video game Pac-Man, gobbling up particles and getting rid of them on the mucociliary escalator, or through the lymphatic system. The lymphatic system is like a storm drainage system that works to get rid of unwanted fluids and materials. However, if there are too many particles, these macrophages become overloaded and can't remove the particles from the lung. Well, what happens then? If too much silica dust is inhaled over a long period of time, it overwhelms the lung's defense mechanisms. This starts an inflammatory process in the lungs. As the dust begins to collect, the overloaded macrophage cell walls rupture and release fluids which result in inflammation. This triggers other specialized lung cells to come to the area of inflammation. These special cells, called fibroblasts, attempt to wall off or surround the silica particles in an effort to protect the lung. This is done by forming scar tissue to isolate the silica particles. This scarring is similar to the process that happens after you cut your finger in the scar forms as the cut heals. When this scarring action occurs in the lung, it continues to progress and it can reduce the lung's ability to expand and contract and can impair its ability to take oxygen and give off carbon dioxide. If too much healthy lung tissue is replaced by scar tissue, you develop complicated silicosis, which may be a disabling disease that can eventually cause death. Does the amount of dust I'm working in effect whether I get the disease or how bad it is? Oh, definitely. There are basically three types of this disease. Acute, accelerated, and chronic. They're characterized by the speed in which the lungs get overloaded and scarred. Now, this speed is determined by the amount and duration of exposure. Acute silicosis can develop within a very short time, within a few weeks to four to five years of exposure to exceptionally high concentrations of respirable silica dust. And it usually results in death since the lungs are so rapidly overloaded. The deaths of many people working on the Hawks Nest Tunnel in West Virginia some years ago is an example of how severe and rapid this form of silicosis can be. Keeping the country. Silicosis was taking its toll from the ranks of American workers. Congress has just started to investigate the building of Hawks Nest Tunnel, known as the Village of Death. Accelerated silicosis can result from working in areas of high concentrations of respirable silica dust for a period of five to ten years. It is disabling and often results in death. Accelerated silicosis can progress more rapidly than chronic silicosis, even if the worker is removed from exposure. The third type, chronic silicosis, is the most common form, and can result from exposure to respirable silica dust at relatively low concentrations. It may take ten years or more of exposure before it is detected. It progresses much more slowly, but it can also cause impairment and death. The Mind, Safety, and Health Administration is currently evaluating the scientific information to determine if a new limit should be proposed. Meanwhile, it's always a good idea to keep silica exposure as low as possible. If you find yourself working in an extremely dusty task, ask your employer, miner's representative, or IMSA, what can be done to reduce your exposure? What are the symptoms of silicosis anyway? Do they differ among the types of silicosis? Common symptoms are shortness of breath, fatigue, and difficulty in performing tasks, like walking upstairs. The severity of the symptoms and how soon they occur would differ among the three forms of silicosis. For example, these symptoms would occur rapidly and be very severe for acute silicosis. In the early stages of chronic silicosis, however, the miner may have no symptoms, but the disease may show up on an x-ray. Why an x-ray? Chest x-rays are the best way to detect most cases of silicosis in their early stages. The purpose of an x-ray is early detection of scarring in your lungs. With chronic silicosis, we can often detect evidence of dust exposure in your lungs many years before you would notice any symptoms, such as getting out of breath or tiring easily. If detected early, the company can take action to protect you against further exposure, reducing the possibility that the disease will progress. It is important to get x-rays, but it is just as important to have them read by a physician skilled in the recognition of dust diseases, such as a physician with a B-reader certification issued by NIOSH, the National Institute for Occupational Safety and Health. Well, how often should I have an x-ray? X-rays are taken some years apart because chronic silicosis, the most common form of silicosis, normally takes years to develop. You should have one soon after the start of your employment and then periodically thereafter. NIOSH recommends that ground silica workers have an x-ray every year and for other workers with exposure to respirable silica at least every three years. Then there's some kind of blood test for silicosis, like there is for other diseases? No, maybe someday, but right now the recommended method of detection is a chest x-ray. This is also part of normal medical screening and surveillance procedures for other dust diseases. Is there any cure for silicosis? There is no cure. The scarring of silicosis is irreversible. That's why early detection is so important. What about cancer? I've heard that silica causes cancer and bags of our industrial sand do carry cancer warnings. There are ongoing scientific studies on how breathing silica dust increases risk of developing lung cancer in humans. The International Agency for Research on Cancer, known as IARC, classified crystalline silica in the form of quartz and crystallite as carcinogenic in humans, what is called a Group 1 classification. This determination was based on both human and animal studies. The evidence suggests that the lung tumors in rats result from persistent inflammation and scarring. However, IARC does not provide recommendations as to how to prevent cancer from occurring in humans. Both IMSA and NISA are carefully considering how to best control all hazards posed by silica based on the most current scientific data. A first step in preventing lung cancer is to prevent silicosis so the lungs aren't overloaded and scarred by silica. Some of my friends smoke, and does that determine whether or not you get silicosis? No, it doesn't. Although smoking is the leading cause of lung cancer and it can increase the frequency and severity of other lung diseases, it doesn't appear to increase the risk of developing silicosis or its progression. As you know, I'm always encouraging my patients to quit smoking to improve their overall health, but let's stay on silicosis for now. What are some of the things that can be done to help prevent silicosis? There are many things that can be done. The first line of defense is good engineering control, so that workers aren't exposed to silica dust. Your employer, under the Mind, Safety and Health Act, must provide a safe and helpful workplace. You can help management maintain the dust collection and ventilation systems your company has installed. Make sure you report problems with these systems when they occur. Good housekeeping and proper cleanup of dust are important. Never dry sweep. Use a vacuum system or water cleanup method. Work with your supervisor to help reduce dust exposures by reporting leaks, malfunctions and spills. Follow good work practices and don't create more dust by leaving inspection ports or doors open. Avoid areas you know or believe to be dusty and report them to your supervisor so the company can correct the situation. Remember, respirable dust is too small to see, so you can't spot all the hazardous areas. But a visibly dusty area is one that needs checked out. What about respirators? How important are they? I really don't like wear them, sometimes they're uncomfortable. I know respirators can be uncomfortable, but they are extremely important. They work just like the air filter in your car, only more efficiently. When used as a part of a good respirator program, they can be an effective barrier to prevent you from inhaling dust into your lungs while permanent engineering controls are being installed. Although most people are always sensitive to anything on or around their face, respirators can be reasonably comfortable. To be effective, a respirator must make a good tight seal with your face. That usually means no beards or mustaches. You should have a fit test annually, but if the respirator becomes uncomfortable, talk to your foreman or safety director. Sometimes people gain or lose weight or have new dentures and the respirator they have no longer fits or feels comfortable. Often a change in size or model is all that is needed. In order for a respirator to work, it must seal tightly to the face. Now remember, no beards or no mustaches that interfere with the seal of your respirator. That sounds like the prevention of silicosis is a combination of all the things we've discussed. You've got that right. All parts of the silicosis prevention program have to be followed. And especially remember to take advantage of your company's medical surveillance program. Get your routine physical exams, x-rays and pulmonary function tests. They detect disease before their significant damage. One of the most important points to keep in mind, John, is silicosis is a preventable disease. We can all work together to reduce exposure to silica. Well, I've learned a lot from our discussion, doctor. I'm beginning to realize that I play an important role in preventing silicosis. Good. Now if we can get everybody to understand, we can eliminate silicosis from the workplace. Speaking of workplace, my shift's about ready to start. I better get ready to work. Doctor, thanks for talking to me. Thank you, John. Have a good day. Silicosis is a preventable disease. This video was conceived to increase its knowledge about the disease called silicosis, so that it knows the potential risks that health affects when working with the silica and to try to reduce exposure to silica powder. Silicosis is a form of neumocosis that means powder and lungs, or in this case silica powder and lungs. This video will help you identify the risks that work with the silica. It will explain how its lungs and respiratory apparatus are affected by the exposure to silica powder. It will also describe the different types of silicosis and the methods of detection and prevention. Doctor, in our training classes, they talked about silicosis, but I don't really understand what it's about. Silicosis is a disease of the lungs caused by the prolonged inhalation of silica powder. Silicosis is a very abrasive mineral. It comes in three forms. Quarzo, which is the most common, and crystal and tridimita, which are not so common, but more toxic. Silicosis is found in any rock, and in almost all metal and non-metallic minerals. Because the fact that the soil is made up of rocks, the majority of the dust that covers the earth contains something of silica. Now, since the amount of silica or minerals that are in the work area can change, thanks to the program of samples of its company, its security director, its Kapataz, will be able to give you more details about it. It's important to know if the materials with which it works contain silica. What type of silica do they contain and how do they protect themselves? I don't know anything about the lungs, except that they need to breathe. Can you explain to me how they work and how the dust affects them? It would be easier with a blade. If you have time, come with me to the training room. This classroom is very beautiful, John, and it has very beautiful materials. In fact, here is an image that shows very well what I want to tell you. This is a respiratory device, like yours, in which it circulates oxygen through its entire body and allows it to work. When breathing, the air that it breathes passes through a tube called trachea to reach the bronchioles and other smaller conducts called bronchiolos. These give place to the alveolar conducts, functional parts of the lungs, and end up in some sacchites called alveolos. There, the oxygen penetrates in its blood and the carbon dioxide, a product of waste, is returned to its lungs to be exhaled. This is the most important function of our lungs, to introduce oxygen into our body and extract the carbon dioxide. The lung is a unique organ. Remember that anything that can affect the exchange of oxygen and carbon dioxide can cause us health problems. I remember that in some courses, they told us that the respiratory device was cleaned by itself. How do you do that? Good question. It all begins in the nose, where we have some hairs followed by a cell and a layer of mucosa in the nasal passages. The hairs filter the biggest particles that we remove when we hear the nose. As it goes down through the respiratory device, another mechanism enters into play. This is called the mucosiliar ladder. It works as a transporter. The mucosiliar ladder cells, which are located in the respiratory vias together with the mucosa, catch the big particles that we sometimes swallow or take out when we spit. This is the first defense of the lungs against bacteria or dust. What happens if some silice particles pass through this first defense? If the silice particles are very small, what we call the breathable dust, they can penetrate the lungs very deeply. But the lungs also have another defense mechanism inside the alveoles. They are called macrophages. They work as the video-pagman game. That is, they swallow the particles and get rid of them thanks to the mucosiliar ladder or to the lymphatic system. The lymphatic system is like a system of rain drainage that is used to get rid of harmful materials and fluids. However, if there are too many particles, the macrophages overload and can't get the particles out of the lungs. What happens then? If too many silice particles are too small, during a long period of time, the defense mechanisms of the lungs are crushed. This causes an inflammatory process in the lungs. When the dust accumulates, the macrophages' walls are overloaded and they let fluid escape, which end up causing inflammation. This causes other cells in the lungs to penetrate the area of inflammation. Those cells, called fibroblastos, try to separate or surround silice particles in an effort to protect the lungs. For this, they form a scarlet tissue that is used to isolate silice particles. This process is similar to what happens when a finger is cut, a scarlet shape while the finger is cured. When this happens in the lungs, the scarlet continues to grow and it can reduce the ability of the lungs to expand and contract. This affects the ability to inhale oxygen and to exhale carbon dioxide. When a large part of the pulmonary tissue is replaced by a scarlet tissue, it can develop a complicated silicosis that can even cause death. The amount of dust that there is where you work could be that it could infect the disease or temperate it. Of course, there are three types of silicosis. A high-accelerated and chronic silicosis. The difference is the speed at which the lungs are overloaded and chiseled. This speed is determined by the amount and the duration of the exposure. The high-accelerated silicosis can develop in a very short time. From a week to four or five years of exposure to extremely high concentrations of breathable silice powder. The people who contract it almost always die due to the rapid overload of the lungs. The deaths of many miners who worked in the Hawks Nest tunnel in Virginia del Oeste is an example of the gravity and the speed of this type of silicosis. The silicosis has charged numerous victims among the American workers. The Congress has just started to investigate the construction of the Hawks Nest tunnel known as the town of death. The accelerated silicosis can be contracted by working for five or ten years in areas with high concentrations of breathable silice powder. It can cause imbalance or even cause death. The accelerated silicosis can worsen even more quickly than the chronic silicosis despite the fact that the worker is no longer exposed to the silice powder. The third type, the chronic silicosis, is the most common way and can be caused by the breathable silicosis in relatively low concentrations. The exposure time can be about ten years or more before it is detected. It progresses much slower but it can also affect health and even cause death. The Ministry of Health and Mineral Security is evaluating scientific information to determine whether it is necessary to propose a new limit. Meanwhile, it is recommended to reduce the exposure to the silice at the minimum. If you work in an environment where there is too much dust, ask your employer, your representative, or the M.S.H.A. what can be done to reduce the exposure to the silice powder? What are the symptoms of the silicosis? Are they different according to the type of silicosis? The symptoms are more common than the lack of breath, fatigue and difficulty in carrying certain tasks such as climbing the stairs. The gravity of the symptoms and how fast they are presented depends on the type of silicosis. For example, these symptoms are presented quickly and are very severe in the acute silicosis. When you barely find the chronic silicosis, the miner may not have any symptoms, but his illness can be seen in a radiography. Why a radiography? Because normally it is the best method to detect the silicosis in his precocious state. A radiography can detect the scars of the lungs. With chronic silicosis, we can often detect the exposure to the powder in his lungs, even several years before you have any symptoms, such as the loss of breath or easily getting tired. If it is detected quickly, the company can take actions so that it does not expose itself to the powder and thus reduce the possibility that the disease advances. It is so important to get a radiography such as the fact that its results are read by a doctor specialized in the identification of diseases caused by the powder, that is, a doctor with a B-lector certificate issued by the National Health Institute and Occupational Security, known as NIOSH. When should you get a radiography? The radiographies are taken a few years later, because the most common form of chronic silicosis of the silicosis needs a few years to develop. You should get a job when you start working and then get another job periodically. NIOSH recommends that the miners who work in contact with the silicists get a radiography every year and that the other workers who breathe silicists get one every three years. Is it necessary to do a blood test for the silicosis as for other diseases? No, maybe one day, but now the method of recommended detection is breast radiography. This is also part of the normal medical tests and the surveillance processes for diseases contracted by powder. Is there a cure for the silicosis? No, there isn't. The scar for the silicosis is irreversible. That's why precocious detection is important. And cancer? I've heard that the silicosis causes cancer and the bags in our industrial arena bring warning about cancer. Scientific studies are being carried out on how the fact of inhalation by the silicist can increase the risk of developing cancer. The International Agency for Cancer Research, called AIARC, classified the crystalline silicis under the form of quartz and crystal as a genic carcinogenic for human beings. This type of silicis comes from the classification of group 1. This was based on studies carried out by human beings and animals. The evidence suggests that pulmonary tumors in rats are due to persistent inflammation and psychotry. However, AIARC does not give any preventive measures to prevent cancer from developing in human beings. The M.CHA and the NISA are seriously analyzing how to control all the risks that the silicis presents from the current scientific data. To prevent pulmonary cancer, the silicosis should be avoided. In this way, the pulmonary tumors would not be overloaded or psychotry. Some of my friends smoke. They can catch the silicosis by doing it. No, not at all. Although the cigarette is the first cause of pulmonary cancer and it can increase the frequency and gravity of other pulmonary diseases, I don't think it increases the risk of developing the silicosis or worsening it. As you know, I always encourage my patients to stop smoking so they can improve their health in general. But let's get back to the topic of the silicosis. What are so many things you can do to prevent the silicosis? There are many things you can do. The first is to establish a good technical control system so that the workers are not exposed to the silice powder. According to the Ministry of Health and Minerals, its employer has to offer a safe and healthy workplace. To help its administration, they should preserve the capture systems and the ventilation of the powder from its company. Report the problems you may have with these systems. Keep good habits of cleaning, especially what the powder refers to. Never dry it. Use a water-cleaning or vacuuming system. Collaborate with your supervisor so that the exposure to the powder is reduced and report leaks, failures and rams. Adopt good work practices and don't believe more powder by leaving openings or doors of open inspections. Avoid places full of powder and report it to your supervisor so that your company can remedy this situation. Remember, since the size of the powder can't be seen, you can't see all the dangerous areas. An area that is seen with a lot of powder needs to be verified. How important are the breathing masks? I don't like wearing them. They're not very comfortable. I know breathing masks are very comfortable, but they're extremely important. They work like the air filter in your car, but they're much more efficient. When they're used in the brand of the program of a good respiratory team, they can be an effective barrier for not inhaling powder while installing permanent technical control systems. Although most people are sensitive to everything they put on their faces, breathing mask can be very comfortable. To be efficient, a breathing mask needs to be adjusted hermetically to their face. This implies not having a beard or a mustache and also verifying their adjustment every year. But if the breathing mask is unbearable, it can be used with your hood or with your safety director. Sometimes people are fat, thin, or have a hard tooth, and the breathing mask is no longer comfortable. Often, this is solved by changing the size or the model. To complete with its function, the mask needs to be adjusted to their face. That's why, and to achieve a perfect adjustment of the mask, it's important not to have a beard or a mustache. It seems that the prevention of the silicosis is a combination of everything that I just showed you. Exactly. The prevention program of the silicosis must be followed by the foot of the letter. Remember that it also has to be used by the medical surveillance program that your company offers. Get regular physical tests, X-ray tests and lung function tests. They detect the diseases before it's too late. One of the most important points that John has to remember is that the silicosis is a disease that can be prevented. And that only the team work can reduce the exposure to the silicosis. I learned a lot from what Dr. said, and now I understand the important role that I can have to prevent the silicosis. Good. Now what I have to do is to spread it to the others to completely eliminate the silicosis. Speaking of the others, my turn is about to begin, so I better go now. Dr. thank you very much for the talk. Thank you, John, have a good day. Silicosis is a disease that can be prevented.