The Rise in Silicosis Demands Urgent Action on Silica Safety

As more lung tissue becomes fibrotic, the lungs lose their capacity to function effectively, causing progressive breathlessness, persistent coughing, and, in severe cases, respiratory failure.

The risk and speed of developing silicosis depend on the duration and intensity of exposure to silica dust. There are three main forms of the disease:

• Chronic Silicosis: Develops after prolonged exposure (10-30 years) to low levels of silica dust.
• Accelerated Silicosis: Occurs after shorter, more intense exposure (5-10 years).
• Acute Silicosis: A rare but severe form that can develop within a few months of very high exposure, causing rapid lung damage.

Recent research led by Dr Johanna Feary, a consultant in occupational lung disease at Royal Brompton and Harefield Hospitals, documented eight cases of silicosis in UK workers exposed to engineered stone, highlighting rapid disease onset in some individuals after just 4-8 years of exposure, far shorter than the typical latency for chronic silicosis. These findings published in the British Medical Journal “Thorax” in 2024, indicated that even relatively short exposure at high levels can lead to severe outcomes, including acute silicoproteinosis, a rare and aggressive form of silicosis​

Dr Feary’s study reinforces that exposure intensity plays a significant role in disease progression. While chronic silicosis typically develops over decades of low-level exposure, accelerated and acute forms can manifest after shorter, more intense exposures, particularly in poorly controlled environments. Dr Feary and her colleagues stress the importance of prevention since disease progression can continue even after exposure ceases.

Is Prevention Possible?

Preventing exposure to RCS is inherently difficult due to a combination of factors. Silica is one of the most abundant minerals on Earth and is a key component of many materials used in construction, masonry, and manufacturing. Activities such as cutting, grinding, and drilling release fine silica particles into the air. These particles, often invisible to the naked eye, are small enough to remain airborne for extended periods, making them hard to suppress or capture effectively.

Preventing exposure is possible but requires multiple layers of controls to be effective. Any variation or inconsistency in applying these controls can render them useless. A recent editorial titled, “Should engineered stone be banned?” published in the Journal of Occupational and Environmental Medicine argued that even with preventative controls like wet-cutting and PPE, silica dust exposure remains so difficult to manage that an Australia-style ban should be enforced as the only guaranteed way to protect workers from silica-related disease. With no UK ban on the horizon, applying suitable and sufficient controls whenever RCS is present is critical to keeping workers safe.

Hierarchy of Controls and RCS

Effectively managing RCS exposure requires a structured approach that follows the hierarchy of controls. This framework prioritises the elimination of hazards wherever possible, followed by progressively less effective measures such as substitution, engineering controls, administrative procedures, and, finally, personal protective equipment (PPE). Each level of the hierarchy contributes to minimising risks and must be applied consistently and effectively.

Phasing out high-RCS content materials, such as engineered stone, is an ideal solution. Australia’s ban on these materials demonstrates how regulatory action can reduce exposure and encourage innovation in safer, silica-free alternatives. When elimination is not feasible, substituting high-silica materials with low-silica or silica-free alternatives, can significantly lower the inherent risks.

Engineering controls are essential for managing airborne dust at its source. Local exhaust ventilation (LEV) systems, which capture RCS dust during cutting or grinding, can be effective when properly maintained. Wet-cutting techniques are another method for suppressing airborne particulates during stone fabrication and polishing. However, these measures must be supported by consistent equipment maintenance to ensure their effectiveness. Poorly maintained controls often fail, especially in dynamic work environments such as construction sites or small workshops, where conditions vary widely.

Administrative controls focus on improving workplace practices and management processes to limit silica exposure. Providing comprehensive training and increasing awareness among workers about the risks associated with RCS is crucial. Initiatives like the recently funded Silica Safety Toolkit offer valuable resources for educating workers and employers about best practices. A comprehensive health surveillance programme can enable the early detection of silicosis and other silica-related illnesses through regular lung function tests and chest X-rays. In addition, workplace procedures should establish clear protocols to minimise high-risk activities and ensure the correct adoption of safe working practices.

Finally, personal protective equipment (PPE) acts as the last line of defence when higher-tier measures cannot fully mitigate exposure. Respiratory protective equipment (RPE), such as FFP3 masks or powered air-purifying respirators, must be carefully selected and tight-fitting face masks individually fit-tested to ensure proper functionality. PPE should be regularly inspected, and its components, like filters, replaced to maintain optimal performance. However, reliance on PPE alone is insufficient, as its effectiveness depends heavily on consistent and correct usage, which can be challenging in practice, and it doesn’t protect others who could be affected by any dust produced in the working environment.

A Word of Caution

By implementing controls at all levels, employers can reduce the risks associated with RCS exposure, however, relying solely on lower-tier measures, like Administrative Controls and PPE, should always be secondary to elimination and substitution wherever possible. Dust suppression measures like wet-cutting and LEV can mitigate the risk, but their effectiveness depends on consistent application and maintenance.

Personal protective equipment (PPE), such as respiratory protective equipment (RPE), is a critical control measure but comes with its limitations. Tight fitting RPE  requires proper face-fit testing and all types require training to ensure it works effectively, but many workers either lack access to this training or find the equipment uncomfortable, leading to inconsistent use.

A further challenge is the general lack of awareness among workers and employers regarding the dangers of RCS. Many are not fully informed about the long-term health risks or the best practices for minimising exposure. This combined with the ubiquity of silica-containing materials, make controlling exposure a persistent and significant challenge for industries reliant on silica-based processes.

Conclusion

Silicosis is a life-changing, permanent and progressive disease for which there is no cure. The link between respirable crystalline silica (RCS) and silicosis poses a serious and imminent threat to workers, particularly in industries like construction, masonry, and engineered stone fabrication, where exposure to silica dust is commonplace. Despite advances in protective measures, silicosis remains a significant health risk, with devastating, irreversible consequences for those affected. The recent surge in cases of silicosis linked to the use of engineered stone in kitchen worktops highlights the urgency of addressing this issue.

Wherever possible, RCS use should be avoided, and safer, silica-free alternatives should be considered. However, in cases where that’s not possible, it is crucial that multiple layers of preventative controls are put in place to safeguard workers.

The recent findings from experts like Johanna Feary, underscore the pressing need for stricter regulation and increased industry awareness. The global experience of countries like Australia, where bans on high-silica materials have been implemented, should be taken into account as the UK considers its own regulatory approach.

However addressing the risks posed by RCS requires not only regulation but also collaboration across industry. Initiatives like the Silica Safety Toolkit, recently funded by CITB, aim to empower employers and workers with practical resources for identifying and controlling RCS hazards. Such efforts are vital for bridging the gap between awareness and action, particularly in high-risk industries like construction and stone fabrication.

Ultimately, preventing silicosis requires a collective effort to reduce exposure at its source, protect vulnerable workers, and ensure that the necessary safety measures are consistently applied.