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Fluid injection – the causes and action plan behind reducing life-threatening injuries

Published: 5 December 2018 - Victoria White

The BFPA explains the risks of fluid injection injuries. Although not very common, they can incur life-changing or even life-threatening damage if not dealt with correctly. Prevention is always better than a cure, but if the worst does happen, would you know what to do?

UK Industry, in general, is astonishingly well legislated, especially in terms of health and safety. Labour laws, societal evolution, contemporary human resource practices and an increasingly more litigious and punitive environment have all lead to the development of ever more stringent rules, regulations and procedures relating to human interactions with machinery and plant equipment.

The problem is – and this is endemic with almost all legislation – humans are fallible and will always find a way to make their lives easier, jobs faster, or more hassle-free, even if it means bending the rules a little. In some circumstances this is often ignored, as it may actually develop into more efficient procedures; but when it comes to health and safety – where people’s well-being and even their lives are on the line – these rules should never be considered pliable.

In general, most employees are aware of what is dangerous and what the implications are from not following the rules. Electricity is a great example, where even a simple, innocuous static shock can make the most hardened engineer think twice about touching a metal surface. Gravity is another. Everyone knows you don’t stand under an unsupported load, or work under a machine propped up with bits of wood.

These fears are innate and are learnt in other walks of life, mostly from childhood onwards. But there are other risks in industrial environments that are not part of our regular life experiences; and it is about these that we must be the most cautious and, indeed, exercise elevated levels of training and education.

A case in point would be fluid injection injuries in fluid power applications, although these may also be encountered when using grease guns, pressure washers and paint sprayers. Domestic use is hard to govern, but in industrial settings the issues revolve around education, adhering to the rules and making sure that people not only understand the implications, but also know what to do should a fluid injection injury occur.

Fluid injection injuries can be desperately unpleasant and even fatal in some situations. The problem is that some can appear innocuous at first and are often shrugged off or dismissed. The British Fluid Power Association’s (BFPA) ‘Fluid Injection Injury Emergency’ handbook, states that a pinhole leak in a hydraulic hose can eject fluid at speeds in excess of 180 m (600 feet) per second and a pressure of as little as 6.9 bar or 100 psi – in some circumstances – is enough to puncture the skin, with greater pressures delivering even greater penetration and more severe injuries.

These injected substance pass through subcutaneous tissue and can enter tendons and deep into the hand or body, depending on the injection point. The person injured may initially feel a slight sting and simply blame it on steel reinforcement from a failed hose or an insect bite, but within a very short space of time, pain levels will elevate, indicating that more serious repercussion will occur, should immediate and, indeed, correct professional help not be sought.

For injuries where the fluid entered the bloodstream, the prognosis is just as dangerous, as the body simply does not have a mechanism for ejecting fluid likes these and, if left untreated, this tiny pin-prick injury can result in amputation and, as a result, serious long-term health and employment issues. Septicaemia or legionella may also result these types of incidents.

Although these types of injuries are not very common – an average of 1 in 600 cases of hospital-reported hand injuries, according to a US hand surgery manual – there is no excuse for an employer and its employees not to know what to do should an incident occur. Indeed, the Health and Safety Executive backs this up in its RR976 Research Report, explaining “Although the reported instances of injury through hydraulic injection are comparatively rare in the UK, the potential severity of the consequences to the injured party dictate that understanding, acknowledging and mitigating the risk of injury through hydraulic injection, is essential for any individual or commercial organisation utilising hydraulic systems or equipment.”

The risks still remain high, however, with the Fluid Power Safety Institute (FPSI) in the USA quoted in an article in ‘Construction Equipment’ magazine, saying: “More than 99 percent of people who service, repair and troubleshoot hydraulic systems have been subjected to the exact dynamics that trigger a high-pressure-injection injury. The ‘liquid bullet,’ however, either missed or deflected off its target. If ‘hydraulics’ were a recognised occupational hazard, and thus fell into a category for near-miss reporting, we would be at catastrophic levels.”

Most engineers working in high-pressure systems are acutely aware of the risks. Almost all training regimens point out the danger and teaching is often accompanied by videos showing the potentially destructive nature of faulty hydraulic systems. But, as mentioned before, the human factor comes into it when working out in the field. Simply moving a hose out of the way, or tightening a coupling – perfectly normal tasks – can result in an injury; and to further exacerbate the issue, most of this close-up manual work is performed using the leading hand, so it is this that is affected, further compounding the effects of the injury.

So, the obvious question is what should take place immediately following a suspected injection injury? The aforementioned ‘Fluid Injection Injury Emergency’ handbook from the BFPA contains a process flow in the appendices that highlights the steps that need to be taken. In the first instance the working area should be made safe, to prevent further injury. After this, the emergency services should be called and first aid treatment given, including gentle cleaning, immobilisation of the limb or appendage and elevation into a comfortable position. The guide is at pains to point out that at this stage, patients should not be given any food or fluids as surgical procedures maybe required.

Further appendices explain, with graphical information and a form, that the point of injury must be noted and handed to the medical staff, along with full personal details of the patient, including the time of the injury and the injected media. Due to the scarcity of this type of injury, the final appendix offers guidelines to medical professionals – who may not have experience in this arena – based on input from a number of different learned sources, all of which have been shown to demonstrate a more positive prognosis.

Behind all of this is the need for due-diligence, training and awareness. Any fluid power training course should contain safety modules which demonstrate the risks associated with working with fluids under pressure. Employees need to be aware that taking shortcuts, or circumventing procedures is simply not acceptable and the consequences need to be illustrated. A photograph showing the after effects of a fluid injection injury should be enough for people to gain even more respect for what can be an incredibly dangerous situation.

The human factor means that these injuries will still occur, but their profound effects can be offset to a certain degree with the proper education, support and, of course, incident-related remedial action. Most leading suppliers, backed up by the BFPA, offer in-depth training and can help companies to develop procedures and practices that can define how these incidents are dealt with, so ignorance can and never will be a good enough excuse.

Source: Industrial Compliance


 
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