Good occupational hygiene does not simply measure and report, but rather works toward optimal control of exposures. After determining where controls are required, the type of control measure needs to be selected. Best practice would be to select a few ideal measures and discuss these with the operatives who would use them. This engagement early in the process allows employees to feel involved and listened to, increasing the likelihood that measures would be used effectively. Employees will also likely have valuable insight into the ergonomics of the task and whether planned designs would adversely affect their work; again, designing these issues out would also increase the usage of any planned control measure. Better ergonomics of a task also reduces the potential for frustration and stress, decreasing the mental load and potential for interpersonal issues that could be related to decreased production.

For situations where other controls cannot be instituted, it may be necessary to require the use of personal protective equipment (PPE). Workers can often be resistant to this, due to requirements to shave or increased concerns about health risks, given that the use of PPE is often referred to as the “last resort”. Having good occupational hygiene support in this situation is crucial so that proper training can be given on wearing any PPE and the need for it properly contextualised to allay any concerns. Involving operatives in the selection of PPE can also increase compliance; for example, using level-dependent hearing protection in a high-noise environment may cost more, but will reduce the feeling of isolation and allow better communication, both of which have a positive effect on mental health.

As briefly discussed above, the ergonomics of a task – though often overlooked – is an important part of maintaining efficiency but also reducing the potential for musculoskeletal injury. Having good occupational hygiene provision can contribute in this regard, though unfortunately this level of input is not routinely requested by clients.

As an example, a production line may have a dusty waste product that is removed to bins. The bins are contained within extracted enclosures, but these must be regularly emptied to prevent blockages that would stop production. The timing of emptying is irregular, requiring operatives to keep checking whilst balancing this with other tasks. Emptying them requires a lengthy process where the enclosure is opened, an empty bin pushed through to remove the full one and the waste removed to another area. This therefore requires a significant amount of moving the bins around, increasing the risk of low back pain and injury; operatives also find it to be longwinded and so sometimes manually remove the waste from the enclosure, increasing exposure.

This situation increases exposure, risk of injury and  time taken to complete the task. Exposed or injured employees are more likely to develop health problems, adversely affecting their mental health and potentially leading to lost income, which would exacerbate the situation. Reduced efficiency leads to more production downtime, lowering output and increasing stress across the larger workforce, which could cause friction and interpersonal issues at work, further increasing stress.

Good occupational hygiene support in this case would assess the situation and, ideally, suggest better ways of working to prevent interaction with the material. It would also outline the larger ergonomics of the task and how risk of physical injury can be reduced by removing the handling of the waste material, reducing the potential for production to be affected. The key here would be communicating the holistic view of the situation to management so that they do not just look at the exposure–control situation, but at the wider benefits of adding what may be, at face value, an expensive system. Unfortunately, it can be difficult to do this in practice as though exposure can be demonstrated scientifically, the effects on more ethereal and immeasurable issues such as musculoskeletal health and the potential for additional stress cannot – at least until they happen or after changes have been made and used for a significant period of time.

In addition to the ancillary effects of occupational hygiene practice on positive mental health, it can also be influenced more directly by targeting fatigue and stress. Though not the core of hygiene practice, they fall firmly within its remit and are often addressed by in-house hygienists or consultants working in fields such as construction.

The link between fatigue and mental health is well documented, especially in shift workers. Disruption of circadian rhythm is associated with increased stress and a higher incidence of depression and anxiety. The hormone-disrupting effects of night work are also linked with breast cancer, such that it is classified by the World Health Organization as a category 2A carcinogen. Other than the psychological and physical effects of fatigue itself, the pressures put on the home lives of workers by shiftwork can often increase levels of stress. For example, workers on regular night shifts have less time to interact with their families, engage in hobbies or attend medical appointments, all of which are likely to have a deleterious effect on their mental health. If they are moved to a rotating shift, their families may not be understanding of this, causing strains on relationships and increasing overall stress levels.

Hygienists can have a positive influence on the hazards posed by fatigue by becoming involved in developing fatigue management plans, conducting risk assessments and modelling fatigue levels. Ensuring that members of senior management and other decision-makers are aware of the far-reaching effects that changes to shift patterns can have is the first step in this. Once buy-in is achieved at this level, the workforce needs to be properly consulted and options offered for the variety of shift patterns available, with pros and cons, such as accumulated fatigue levels and recovery times clearly laid out. Involving employees in such decisions is undoubtedly of benefit, but it is unlikely that all will be happy with the final decision. Providing a clear rationale informed by the various practicalities that the business must consider and the health-related issues identified by hygiene input will be of benefit here. Regular review, including indicators of fatigue such as accident or near-miss records, employee satisfaction and productivity should also be undertaken with a hygienist so that they can provide advice and guidance on any changes being considered.

Stress is also intrinsically linked with positive mental health; like fatigue, increased workplace stress is associated with an increased incidence of depression and anxiety. It can also exacerbate existing mental health conditions, resulting in reduced work performance and absenteeism, which themselves have the potential to further increase stress.

In terms of good occupational hygiene, this can be approached using the HSE’s Management Standards model, which assesses stress at work across the following six domains: demands, control, support, relationships, role and change. In day-to-day practice, being cognisant of these domains and tailoring advice and interventions can be of benefit. For example, encouraging the involvement of employees in decisions about their work can be positive with respect to the change domain. Those for whom any change feels thrust upon them would be at risk of increased stress, so advising them of intentions to change processes and asking for their input can ameliorate this. Similarly, ensuring some flexibility in the way tasks are completed, such as when using ergonomic assessments, can be positive within the control domain – those who feel that they have a say in how they complete tasks, provided it is safe and healthy, would be less likely to experience stress as a result. The provision of good-quality occupational hygiene that engages workers also contributes positively to the support domain, especially if training is provided and management staff can then continue this by working with their direct reports to solve problems.

If stress is identified as an issue in the workplace, occupational hygienists can also provide some more direct interventions. The Management Standards is designed as a tool to assess stress levels in a workforce to assist in the provision of targeted control measures, supported by the use of focus groups of employees to discuss issues in more depth. This typically requires a good deal of buy-in at the senior level and can take several days of work, so it is unlikely to be facilitated by a hygienist unless they are in-house or a long-term consultant. However, if a consulting hygienist can become involved in such a process, the methodological approach for which our discipline is known, combined with the objectivity of an external consultant, would be of benefit in facilitating such a program.

At first glance, it may be difficult to see how occupational hygiene supports positive mental health. However, when taking a holistic view of the worker’s overall health – both physical, mental and social – it becomes clear that we as occupational hygienists have a significant role to play.

As an extreme example, imagine a worker where an occupational hygienist has been able to influence all aspects of their role. This person attends work every day and is exposed to minimal physical and chemical hazards, because they have been quantified and controlled by elimination, substitution and engineering controls. They have been involved in the design of local exhaust ventilation systems and other control measures, so are able to complete their tasks with ease, but also have a good understanding of why measures are in place and how to tell if they are working. Because exposures have been controlled, they only have to wear hearing protection or a mask for specific tasks where exposure risk is increased; as such, they are able to communicate with their colleagues, where previously they wore hearing protection for the whole shift. When they wear a mask, they also understand why and, more importantly, how to properly use it. They had back pain before, but because parts of the task have been automated to reduce exposures, the employer was also able to engineer out a significant amount of manual handling, so the employee no longer goes home tired, injured and considering calling in sick the next day. Previous production problems, partially due to cumbersome control measures or the health and safety team stopping work because of unsafe or unhealthy practices, have largely ceased, and so everyone from senior management down is more content and has time to address other employee concerns. When new staff are recruited, everyone can explain not only how a task is completed but why it is done that way, because the hygienist has provided high-quality training. Their shift pattern is also more stable, with only five days of nights a month, rather than a 2-2-2 pattern of days-nights-rest, allowing personal appointments and social engagements to be planned better and ensuring that they are not regularly tired when rotating from a night shift. Because of reduced fatigue and better musculoskeletal health, they feel more able to attend the gym and play sports, improving their overall wellbeing and social relationships.

This person’s reduced health concerns about work, better musculoskeletal health, lack of fatigue and reduced work-related stress boosts their positive mental health. This frees them from the burdens of work bleeding into their home life, allowing them to be more resilient in other areas, rather than the majority of their worries stemming from work-related or work-affected issues. Though not solely related to the work of occupational hygiene, it is clear to see how a properly utilised hygienist can have a far-reaching effect not just on physical but also mental health. The challenge that remains is raising the profile of occupational hygiene to make its use among smaller businesses more commonplace, either through increased use of consultancy or even just better training of stakeholders like health and safety specialists in the implementation of good occupational hygiene methods and practices.