Artificial stone and the rise of silicosis

Engineered stone has hit the headlines over the past year as doctors in the UK have expressed concerns about the role the silica-containing material appears to be playing in driving an increase in cases of the lung disease silicosis, prompting industry experts to call for a ban on stone products with a high silica content.

With luxury stone kitchen worktops, such as those made from marble and granite, often prohibitively expensive for homeowners, stonecutters and kitchen worktop manufacturing workers are increasingly using more affordable materials like engineered stone; a man-made composite material, primarily composed of crushed natural stone (containing quartz) and resin, formed into slab. Quartz is a naturally occurring mineral found in many types of rock, but some types of quartz contain over 90 per cent silica.

Respirable crystalline silica (RCS) is a fine dust created by the cutting, grinding or polishing of materials containing silica. The dust is fine enough to permeate the lungs and can cause a number of serious and sometimes fatal lung diseases, including silicosis, chronic obstructive pulmonary disease (COPD) and lung cancer.

Respirable crystalline silica (RCS) is a fine dust created by the cutting, grinding or polishing of materials containing silica. Photograph: Casella

Quartz is one of the hardest minerals on Earth, making it ideal for use in engineered stone surfaces. These worktops are made by combining natural quartz crystals with resins, polymers and pigments to ensure quality, strength, hardness and durability. This creates an ultra-durable surface with consistent colouring and patterning, unlike natural stone, which varies from slab-to-slab.

If workers are at risk of breathing in quartz dust, it is essential employers take the necessary precautions to prevent exposure, as this undoubtedly will help save lives.

Health risks

Cutting quartz worktops can pose serious health risks, primarily due to the high silica content in engineered quartz. There is no single, universally defined ‘safe’ level of silica content but the Health and Safety Executive’s (HSE’s) Workplace Exposure Limit (WEL) for silica is designed to minimise employees’ risk of exposure by requiring employers to ensure their control measures are effective in keeping exposure below
the level specified in the WEL.

As well as silicosis, lung cancer and COPD, workers repeatedly exposed to silica dust over time may suffer from other respiratory conditions, such as lung scarring and even respiratory failure. HSE-commissioned research estimated silica was responsible for the death of over 500 construction workers in 2005. The potential for disease has been compared to asbestos-related illnesses, prompting some countries, like Australia, to ban high-silica quartz to protect workers’ health.

Complete ban

Research from Monash University published earlier this year confirmed the alarming scale of silicosis cases among workers in Australia, with evidence suggesting the problem extended across multiple regions of the country.

The study found that 90 per cent of the 536 silicosis compensation claims made in Victoria state between 1991 and 2022 were lodged after 2014. This constitutes a 27-fold increase in silicosis claims compared to the previous eight-year period. Researchers described the increase as “disturbing” and urged other countries to take urgent action to prevent further cases. 

Other key findings from the report include:

• 97 per cent of patients with silicosis worked in the stone benchtop industry, and 95 per cent primarily worked with artificial (engineered) stone
• There were 210 patients with silicosis diagnosed by respiratory physicians in Victoria state between May 2019 and December 2022
• 22 per cent of the patients were diagnosed with more advanced complicated silicosis.

Recent media reports stated that 13 tunnel workers in Sydney have been diagnosed with silicosis, adding to concerns that the impact of engineered stone will be felt for decades, among workers who were exposed in occupational settings other than work with artificial stone.

Australia became the first country to ban engineered stone in 2024 following a dramatic rise in silicosis cases among workers. The ban prohibits the use, supply and manufacture of engineered stone, and the restrictions were extended in January 2025 with a ban on the importation of the material. The decision was based on recommendations from Safe Work Australia, the country’s policy-setting body for occupational safety and health, which found clear evidence linking silica dust exposure to silicosis and other fatal lung diseases.

The UK now faces pressure to consider a similar ban. Since 2010, cases of silicosis due to artificial stone have been reported from Israel, Spain, Italy, the US, China, Australia and Belgium. Although artificial stone has been used in the UK for a similar length of time, the country reported no cases until mid-2023, when eight men with silicosis suspected to be due to exposure during the manufacture and installation of stone kitchen worktops were referred to the occupational lung disease department at the Royal Brompton Hospital in London.

Personal, bodily-worn devices do not detect RCS specifically and need to be calibrated if the employer wishes to estimate the amount of RCS dust present. Photograph: Casella

The apparent lack of any reported cases of silicosis due to working with artificial stone in the UK up to recent years is most likely because the respiratory diseases and conditions that RCS causes generally have a long latency. In some cases, those exposed to the dust may not develop lung diseases or cancer until decades later. However, silicosis has been known in certain circumstances to develop quite aggressively and rapidly.

For instance, the eight men admitted to Brompton Hospital with silicosis had a median age of just 34 and had been dry cutting and polishing artificial stone worktops without adequate exposure controls being in place, according to a study of the cluster of cases published in the journal Thorax.

Following the emergence of the cluster of silicosis cases among the UK stone workers in 2023, Dr Jo Feary, a consultant in occupational lung diseases at Royal Brompton Hospital, who conducted the study published by Thorax, called for urgent action to protect workers from preventable harm: “What’s really striking is that this disease is affecting young people in their 20s and 30s, and there is no treatment for it,” she warned. “If they didn’t do their job, they wouldn’t have this disease. We need urgent action.”

According to a report in the British Medical Journal (BMJ) in 2024, a group of doctors led by Dr Feary have since called on the UK Government to follow Australia’s lead in banning artificial stone worktops. The group warn the cluster of cases reported by Brompton Hospital highlights the urgent need to protect the respiratory health of other UK workers who manufacture and install artificial stone worktops.

According to the BMJ, the study led by Dr Feary revealed that all eight of the workers identified by Brompton Hospital had been employed by small companies with fewer than 10 employees. Most of the eight were migrant workers, which meant they may have been at greater risk of exploitation by unscrupulous employers through exposure to unsafe working conditions.

Exposure monitoring

According to the HSE guidance document, Controlling exposure to stone dust (HSG201), an employer may need to carry out airborne exposure monitoring for RCS to assess and demonstrate their exposure controls for silica dust are adequate and effective. HSE says exposure monitoring for airborne RCS is usually based on personal air sampling to collect respirable dust using a pump and sampling head specifically designed for RCS. The sampling head is normally positioned on the worker’s lapel, so it is within their ‘breathing zone’. Laboratory analysis is then used to determine the crystalline silica content in the dust collected.

Personal exposure data, expressed as an 8-hour time-weighted average, can then be compared to the WEL to ensure that exposure is being maintained below the WEL. The WEL for RCS is currently 0.1 mg/m3, and this is set out in the HSE document, EH40/2005 HSE Guidance on Workplace Exposure Limits, which was last revised and published in January 2020.

Static (or area) monitoring, using the same sampling and analytical methods, can also be useful, says HSE. This type of monitoring can help identify the main sources of dust emissions and can be used to monitor trends in airborne RCS levels in the workplace. However, HSE warns that the results of static or area monitoring should not be compared to the WEL, as only personal exposure monitoring should be used to determine compliance with the WEL.

Real-time monitoring devices are also available and can provide ‘instantaneous’ measurements of dust in the air. However, personal, bodily-worn devices do not detect RCS specifically and need to be calibrated if the employer wishes to estimate the amount of RCS dust present. There are larger, static monitoring devices that can monitor RCS in real-time.

Plus, monitoring devices may provide useful information – for example, identifying sources of high dust exposure; aiding the implementation of effective engineering controls to minimise dust exposure; and forming part of active control systems that are triggered if dust levels rise above pre-determined limits. However, the indicative nature of the measurements provided by these devices means they are not suitable for determining whether personal exposures are below the WEL.

What UK law says

Employers must assess and control the risks from dust exposure under the Control of Substances Hazardous to Health Regulations 2002 (COSHH) (as amended). As well as carrying out a risk assessment to determine the nature and extent of employees’ exposure to hazardous substances – and introducing suitable control measures to either eliminate or reduce the associated risk of harm to employee health – employers must provide appropriate information and training to workers.

In fact, the importance of employers and workers understanding how best to prevent exposure to RCS was highlighted in a report from the All Party Parliamentary Group (APPG) for Respiratory Health in January 2023. The report, Improving Silicosis Outcomes in the UK, recommended that:

• The Department for Education considers the inclusion of silica-related risk as a compulsory syllabus item for all building and construction modules in government-funded apprenticeship schemes and further education courses
  
  
• HSE undertakes an industry awareness campaign on the dangers of RCS in order to improve compliance with the existing WEL for RCS
  
  
• HSE assesses and determines the data and technology needed to allow the UK to reduce the WEL for work with silica to 0.05 mg/m3
  
  
• HSE takes active steps to investigate real time monitoring systems as a matter of some urgency, to determine and share the data sets that it deems to be necessary to take this forward and liaise with industry to speed the process and introduction of real time monitoring systems
  
  
• HSE actively considers and consults with industry on the position of real time monitoring to complement the hierarchy of control.

Conclusion

With engineered stone countertops looking set to become ever more popular among homeowners – and the medical profession and industry beginning to understand more about the health effects of exposure to silica dust created during their manufacture and installation – employers must be prepared to do more to protect employees from the adverse effects of exposure to silica dust during the manufacture and end use of these products and materials.

In the UK, calls for the introduction of a lower WEL for RCS, additional HSE enforcement of employers who fail to ensure suitable exposure controls are in place for RCS and further general demands from campaigners for greater exposure controls for RCS, are likely to result in greater public scrutiny of those employers who are failing to adequately protect employees from RCS.

Like the UK, there currently appears to be little appetite in Europe for a ban on the production, use and supply of artificial stone, according to research by the German national newspaper, Süddeutsche Zeitung. “From a German and European occupational safety perspective, bans are only very rarely indicated,” Germany’s Federal Ministry of Labour told the media outlet.

Instead, Germany relies on employers adopting the exposure protection measures set out in the Technical Rule for Hazardous Substances TRGS 559, which sets out requirements for handling substances containing quartz and ensuring safe work with quartz-containing materials. In 2022, the German Social Accident Insurance scheme recorded 295 cases of silicosis as an occupational illness, significantly fewer than in previous years. However, the Association of German Engineers (VDI) noted that in the past, mining took place on a much larger scale in the country compared to today, which may have contributed to higher disease figures being reported in past years.

Whether or not the UK eventually introduces a ban on artificial stone, employers in the UK need to take stock of the appropriate preventative and safeguarding measures to adequately control exposure. They must also ensure staff are trained and educated on the dangers posed by the associated dust.

For more information see: casellasolutions.com

Tim Turney is Global marketing manager at Casella