8111212 Personal protective equipment and legal banning for preventing asbestos exposure in workers – two systematic reviews

<h3>Objectives</h3> Asbestos exposure can lead to asbestos-related occupational diseases. Two reviews were performed to evaluate risk reduction, namely legal banning (LB), and personal protective equipment (PPE). <h3>Material and Methods</h3> For LB we searched MEDLINE, Embase and websites of the US and British Geological Survey as well as the International Ban Asbestos Secretariat. Time trend of production, import and export of asbestos among workers or the general population were compared before and after a partial or full asbestos ban. Included PPE studies measured asbestos concentration outside and inside PPE, considering outside concentration as a surrogate for no PPE. <h3>Results</h3> The effects of LB on asbestos consumption are heterogenous. The most consistent decrease occurred five years before introduction of a partial ban. There were only small changes after the implementation of a full ban. The effect sizes for LB decrease in later decades, e.g. the Dutch consumption to zero after full ban. Almost all types of studied respiratory PPE inside measurements complied with the current EU limit of 0.1 f/cm3 regardless of the asbestos concentration in the environment. Only respiratory protective equipment with a clean air supply reduce workers’ exposure to asbestos to below the proposed European occupational exposure limit of 0.01 fibres/cm3 air. <h3>Discussion</h3> Both LB and PPE are potential effective preventive measures in terms of primary prevention. LB seems to mark the end of a period of anticipation on total asbestos banning and public discussion. However, the risk of bias was high for all countries because the introduction of the ban could not be separated from other factors that affected the time-series other than banning asbestos. To increase the confidence of the evidence in PPE effectiveness, there is a need for larger studies that also measure potential confounders such as risk perception and fit testing.