June 6, 2020

Improving Health and Addressing Emerging Concerns in Construction

By Kay Bechtold

Industrial hygienists must take action to address pressing health and safety concerns in the construction industry, argued Barbara Epstien, MPH, CIH, FAIHA, at Virtual AIHce EXP 2020 on Tuesday morning. Epstien, a certified industrial hygienist at the Oregon-Columbia Chapter of the Associated General Contractors of America, discussed the need for increased awareness and efforts related to four major health hazards in construction—manual material handling, noise, air contaminants, and high temperatures—as well as challenges associated with the opioid epidemic, mental health, and the ongoing COVID-19 pandemic. Epstien urged fellow occupational health and safety professionals to apply their knowledge and skills in the dynamic, mobile, multilayered settings of the construction industry.

COVID-19 presents an unusual challenge for construction and other industries. Unlike most traditional workplace hazards, the source is the worker, especially if he or she is asymptomatic or presymptomatic for COVID-19. Because of pandemic conditions, OHS professionals and employers must consider, perhaps for the first time, actions such as screening workers for illness before they enter job sites and revisiting sick leave policies.

In addition, the “classic construction culture” of working through pain and continuing to work while sick is particularly problematic during a pandemic, Epstien said. She discussed several ways for employers to use the hierarchy of controls to protect construction workers from exposure to SARS-CoV-2, the virus that causes COVID-19. Providing more handwashing stations; scheduling work to avoid “trade stacking,” or situations in which multiple employers have employees working together in small spaces; and scheduling safety meetings in small groups to maintain six feet of distance between participants are examples of steps employers can take. Epstien acknowledged that solutions are needed for circumstances in which two or more employees must work in close proximity in order to complete certain constructions tasks safely. With personal protective equipment in short supply, one company she knows of used a temporary hinged plexiglass barrier for a lift basket so that two employees could be in the lift together while controlling the spread of droplets.

Epstien was part of the project team for the AIHA guidance document “Focus Four for Health: An Initiative to Address Four Major Construction Health Hazards” (PDF), which was developed by the AIHA Construction Committee and published in June 2019. “Focus Four for Health” highlights the significant effects that health hazards have on construction workers and businesses and provides practical steps for controlling them. The guidance is a companion piece to the industry’s long-running “Focus Four” safety program, which targets the top four traumatic injury hazards in construction: falls, electrocutions, struck-by injuries, and injuries resulting from workers getting caught in or between objects. OSHA launched the “Focus Four” safety initiative in 1994. AIHA’s health guidance is intended primarily for construction contractors and workers, but Epstien explained that it’s also useful for other stakeholders as an outreach and training tool.

The project team selected the hazards discussed in AIHA’s document—manual material handling, noise, air contaminants, and high temperatures—in part based on “impact criteria” such as severity of the health effects, how many workers and trades are likely affected, the availability of solutions that employers can use to reduce exposures, and current awareness of the hazards.

“The hazards themselves aren’t emerging per se—they’ve always been there,” Epstien said. “But we’re hoping that greater awareness of construction health hazards is and will continue to emerge.”

Epstien noted the success of the “Focus Four” safety initiative in preventing injuries in construction and hopes that the new focus on health hazards will produce similar results. She explained that efforts related to health have historically lagged behind those for safety, largely because it is difficult to visualize health hazards such as harmful airborne contaminants. Other reasons for this gap include challenges related to the accuracy of occupational illness reporting and infrequency of OSHA health compliance inspections compared with safety inspections.

“These hazards aren’t going away without our help,” Epstien said. “The project team has done a lot of outreach starting with our peers, but more of us need to reach out to the users of this resource to get the word out.”

Emerging concerns in the construction industry include the opioid epidemic and challenges related to mental health and suicide. Epstien acknowledged the national response to the opioid crisis, which focuses mostly on preventing overdose deaths, changing prescription practices, and finding the best treatments.

“We know these efforts are important and necessary, but they’re not enough,” she said. “We need to also get to the root cause and help the industry recognize and prevent injuries that trigger the need for pain medications in the first place.”

Too often, medicated workers return to the same job they were doing when they were injured, which increases the likelihood of reinjury, Epstien explained. She urged industrial hygienists and occupational health and safety professionals to make their primary goal to prevent injuries and illnesses so that fewer workers need medical care involving pain treatment.

Another area of focus should be stepping up suicide prevention efforts in construction, Epstien said, noting that “suicide fatalities are trending in the wrong direction.” Data from 17 states published by the Centers for Disease Control and Prevention indicates that construction and extraction had the highest male suicide rate among all occupational groups in 2012 and 2015. Known contributing factors for suicide and many aspects of working in construction create a “perfect storm of risk.” Epstien discussed construction’s “tough-guy culture” and high-pressure environment; the need to travel to remote projects, which results in extended separation from family and friends; sleep disruption due to work schedules and rotating shifts; seasonal employment, which can lead to worry about layoffs; and workers being promoted to supervisor roles without being provided leadership training as factors that can affect construction workers’ mental health. Chronic pain, physical strain from years of manual labor, prevalence of alcohol and substance use, and stigma of mental illness are additional risk factors in construction.

The industry also has low usage of employee assistance programs, or EAPs. Epstien attributes this to either a lack of available information about or mistrust of EAPs. She urged employers to train supervisors on how to integrate suicide prevention into safety culture and programs. Employers should also work to identify employees who might be in the early stages of a mental health crisis, and workplaces must be prepared to respond effectively if a suicide occurs.

Tools and resources for suicide prevention can be accessed from the Construction Industry Alliance for Suicide Prevention, CPWR, the Associated General Contractors of America (AGC), CDC, and others.

Epstien argued that OHS professionals need to help shift the paradigm of the construction industry from a “fix-it-with-duct-tape” approach to one where promoting health and safety is more than simply maintaining and using equipment and tools in a safe manner.

“Remember that everyone reacts differently to stressful situations and that it’s okay to talk about it,” Epstien said. “Be supportive, listen, and include mental health and suicide prevention topics in safety meetings.”

Kay Bechtold is managing editor of The Synergist.