Surveillance of occupational health in construction and civil-engineering workers handling engineered nanomaterials
Résumé
Rationale: Entrusted by the Ministries of Health and of Labour, the French Public Health Agency have established, since 2014, the Epinano epidemiological surveillance system of workers potentially exposed in industries to engineered nanomaterials (ENMs) released during their synthesis or incorporation in matrices. The governmental national occupational health action plan 2016–2020 has dedicated a special attention to the question of ENMs exposure in workers in the construction and civil-engineering (CCE) sector. Thus, a steering committee was established to adapt the methodology to efficiently capture exposed workers on sites. Objectives: Beforehand, epidemiological and contextual components were collected in order to apprehend the methodological challenges in designing longitudinal studies on the topic of exposure to ENMs on CCE sites. Methods: A structured PubMed review and web-search of scientific and technical documents regarding ENM-based CCE products was undertaken, completed by in-depth experts’ interviews. Results: Three groups of methodological challenges were primarily identified: (i) Definition of the scope of the population, with involvement of enterprises of all sizes and activities; Heterogeneity of the population occurring on sites. (ii) Circumstances of exposures: No inventory identifying all the products incorporating ENMs; Lack of detailed information on product composition; Heterogeneity of ENMs incorporated in various matrices; Diversity of activities generating exposure variability in terms of product types, duration and intensity of exposure; Passive exposures of workers operating nearby activities involving ENMs and generating dust and aerosolisation; Possible interactions with other risk exposures in light of the multitude of chemicals used on construction sites. (iii) Defining the organizational arrangements to capture efficiently the study population and optimize data collection and monitoring procedures: Lability of the population, influenced by the duration of projects, a known high turnover generated mainly by the engagement of temporary, independent or foreign labourers, and intervention of multiple subcontractors; Regarding small, medium or micro-sized businesses, no service Health Safety Environment (HSE) and relocation of the occupational medicine. Conclusions: Implementing of such a study can be deeply influenced by the political context as well as the product marketing strategies along with the industrial secrecy. The use of ENM-based products would be probably increased in the current green economy context. This underscores the need to implement a specific surveillance system, despite the methodological complexity. Discussions are underway within the steering committee in order to find out strategies.