Occupational Medicals

Hand and Arm Vibration Syndrome (HAVS)

It is estimated that 5 million people may be exposed to HAVS in the UK

Hand Arm Vibration is transmitted from a work activity into someone’s hands and arms. This occurs when:

• Operating hand held power tools
• Using hand guided equipment, eg.: a vibrating compacter, or
• Holding materials being processed by a machine

Regular and frequent exposure to hand arm vibration can lead to permanent ill health. This is most likely if contact with a vibrating tool or work piece is a regular part of someone’s job. Occasional or low level exposure is unlikely to cause ill health.

Hand arm vibration can cause a range of conditions called ‘hand arm vibration (HAVS)’. The best known is vibration white finger (VWF), but vibration also links to specific diseases such as carpal tunnel syndrome. For some people symptoms appear after only a few months of exposure but for others it may take years. The symptoms are likely to get worse with repeated exposure and can lead to permanent damage and disfigurement; they can severely limit the jobs that someone is able to do as well as affect family and social activities.

Responsibilities for Employers – Where a works process is likely to pose a high risk of injury or illness consideration should be given to the possibility of discontinuing or replacing the process altogether, a thorough HAVS Risk Assessment will aid this process and help you decide how to protect the health of employees exposed to vibration.

Where it is impossible to eliminate the use of vibrating equipment a health surveillance programme should be in place. It is important to give appropriate information to employees and encourage their full co-operation. Occupational health professionals (nurses and doctors) who are providing clinical assessment and overseeing the health surveillance programme will be able to assist employers to explain the serious nature of the disease and the aims of health surveillance.

A tiered approach to health surveillance

The testing process is divided into 5 stages depending on the severity of damage caused by vibration. The first 2 stages of the screening process can be carried out by a suitably qualified Occupational Health Advisor. Referrals from Stage 3 are passed to accredited Occupational Health Physicians anywhere in the country.

Tier 1 – Initial or baseline assessment
There should be an initial assessment for any new or existing employees before they begin exposure to HAV, this also provides an opportunity to educate workers about measures under their control that will help to reduce the risks from transmission of vibration. This assessment is generally a self administered questionnaire

Tier 2 – Annual Screening Questionnaire
The self administered questionnaire should be repeated annually to form the routine health surveillance for those at risk but without symptoms suggestive of HAVS. If symptoms appear for the first time or progress workers should be encouraged to report them rather than wait for the next round of screening. The HSE recommends that after three years of reporting no symptoms the worker should be referred for a consultation with the qualified professional to fully explore any possible symptoms that may have been disregarded.

Tier 3 – Assessment by qualified person
This should normally follow Tier 2 if symptoms are reported. The assessment should be conducted by the qualified person. The doctor may be involved in carrying out some or all of the assessment in Tier 3, according to the local arrangements made with your Provider.

Tier 4 – Formal Diagnosis
Formal diagnosis is made by the doctor and for certain actions ie reporting cases under RIDDOR 1995 and fitness for work recommendations

Tier 5 – Use of standardised tests (optional)
In addition to clinical findings from Tiers 3 & 4, standardised tests can be conducted for a worker who has signs or symptoms of HAVS. This tier is NOT required as part of routine health surveillance provision for a workforce exposed to HAV, though it is useful for studying the progression of the disease.

Occupational health professionals experienced in the clinical assessment and diagnosis of HAVS undertake specialist training and should hold a recognised Occupational Health qualification in nursing and/or medicine, they should also have undertaken the Faculty of Occupational Medicine’s approved training for health professionals for HAVS.

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