Contact WorkSafe
Tel: 1300 307 877
Email us
24 hour serious incident and fatality reporting line
Freecall: 1800 678 198
Mason Bird Building
303 Sevenoaks St
Cannington WA 6107
View on Google Maps
Appointed Medical Practitioners (AMP) undertaking health surveillance are expected to have an understanding of the potential adverse health effects of respirable crystalline silica, and to use their clinical knowledge to advise on health surveillance for workers in the workplace.
Inhalation of fine respirable crystalline silica dust particles can lead to deposition in the respiratory bronchioles, alveolar ducts and alveoli within the lungs. This results in inflammation, cell damage and ongoing fibrosis with the development of silicosis.
Silicosis is associated with increased risk of chronic obstructive pulmonary disease and reactivation of tuberculosis. There have been reportedly increased prevalence of antinuclear antibodies and autoimmune disease (rheumatoid arthritis). Silica is a Group 1 carcinogen in humans (IARC) with increased risk of lung cancer.
It is important to identify those with significant work exposures and increased risk of silicosis and its complications. Risk factors include high occupational exposure levels, high silica content of the stone or stone product and duration of exposure. In recent years, there have been increased reports from a number of countries (including Australia and UK) of cases of accelerated silicosis among stonemasons in the artificial stone benchtop industry with 3-5 years of exposure to silica dust from dry cutting, drilling, grinding with power tools without adequate respiratory protection.
A baseline health surveillance is recommended prior to commencement of work, followed by annual health surveillance with 2-yearly imaging tests unless otherwise recommended by the AMP. Workers with high risk exposures may request an earlier health surveillance review if concerned about the development of respiratory symptoms including persistent cough, breathlessness or chest pains.
The WorkSafe Health Surveillance Notification form – Silica Dust (respirable crystalline) includes the required health surveillance components:
Recent updates from Queensland health surveillance of stonemasons indicate that dry cutting, polishing, grinding, drilling and machining for 1-3 years, and smoking have been associated with increased risks of accelerated silicosis. The Queensland experience demonstrated that CXR’s were not as sensitive or reliable with the observation that a CXR may be reported as normal with no opacities (ILO classification 0/0) whilst the corresponding high resolution CT scan (HRCT) revealed bilateral apical fibrosis consistent with silicosis. Similarly laboratory respiratory function tests including DLCO were found to be more sensitive and reliable than office spirometry.
LDCT where available (with modified ILO (Kusaka) reporting), should ideally be the initial radiologic screening tool for the detection of silicotic changes given its much greater sensitivity than CXR and comparable radiation dose*.
Although HRCT is more sensitive than a LDCT, it is not recommended as a screening tool, given its higher radiation dose. However, HRCT and laboratory lung function tests may form part of the investigations undertaken by the AMP in the presence of concerning respiratory symptoms or abnormalities on CXR or LDCT.
*Estimated radiation dose:
Health surveillance results are to be sent to WorkSafe Western Australia by the AMP using the WorkSafe Health Surveillance Notification Form (Silica) together with:
The AMP is required to explain the results of the health surveillance to the worker, and provide feedback to the employer to enable remedial action (i.e. review and improve safety controls in the workplace).
The AMP will arrange prompt referral to a respiratory physician (with expertise in occupational lung disease) for assessment, investigations and clinical management where appropriate, based on the health surveillance outcomes. The AMP determines whether further exposure to silica dust should cease pending the outcome of a referral to a respiratory physician.
Respiratory physician advice and workplace environmental controls should be taken into careful consideration by the AMP before determining whether the worker may safely resume work in an environment which potentially exposes them to respirable silica dust and/or other hazardous dust.
Any identified cases or suspected cases of silicosis must be reported by the AMP to WorkSafe promptly. The AMP keeps WorkSafe informed of the outcome of the respiratory physician review by forwarding a copy of the report from the respiratory physician. These cases will require ongoing respiratory physician reviews.
Refer to the WorkSafe WA guidelines for health surveillance when planning and implementing health surveillance.
Safe Work Australia resources are useful as an adjunct resource.
Print ready copy
Last modified: