WNYLaborToday.com Editor’s Note: The Center for Occupational & Environmental Medicine (COEM), located at Buffalo’s Erie County Medical Center (ECMC), is available to Workers both Union and non, providing care to those who are injured, impaired or who develop an illness as a result of workplace factors – which may include exposure issues, physical injuries, or any other job hazard.  The COEM is also a New York State Department of Health-funded Clinic for the diagnosis and treatment of occupational injuries and illnesses for Workers living in the five counties of Western New York.  The COEM also offers services for any Worker with other job-related medical needs, such as physicals required for employment or licensure - and they assist with completion of paper work for Worker Compensation Claims. With state-of-the-art diagnostic equipment and a highly-skilled and caring Staff, the COEM’s Health Care Services meet U.S. Occupational Safety & Health Administration (OSHA), U.S. Environmental Protection Agency (EPA) and Department of Health Safety Standards.  The COEM takes a different approach to the treatment of injured Workers through prevention, early diagnosis and treatment.  Opened in 2015, the COEM was developed with great support from Western New York Labor Unions and their Leadership.  The COEM, which is open Monday through Friday - 9 a.m. through 5 p.m., can be reached at 716-898-5858.

The author of this article is Nellie Brown (pictured below), who serves as the Director of the Workplace Health and Safety Program, a Statewide Program of the Worker Institute at Cornell University’s School of Industrial and Labor Relations.  Nellie provides Industrial Hygiene Services for the COEM.

What is meant by a high-pressure injection injury?

Workplace exposure to chemicals typically occurs by these possible routes of entry: Inhalation, skin/eye contact or absorption through the skin; Ingestion (usually hand-to-mouth transfer); or injection can occur when chemicals make contact with skin that is damaged by cuts, punctures, or bad chapping - the loss of the skin’s protective barrier enables entrance into the bloodstream.

However, a potentially very serious exposure can occur by high-pressure injection when hydraulic fluid, chemicals, air (from pneumatic lines), or powders are forced into the skin by high pressure.

What kinds of work could involve high-pressure injection injury?

Some examples are: Commercial paint spray guns; Hydraulic-powered machinery and equipment; Pneumatic transport of solids such as powders; Compressed air lines; pneumatic tools; Injection molding of plastics; Presses such as hydraulic presses; Pressure washers; and Diesel engine fuel injectors.

Forcing air, liquids, or solids into the skin requires high-pressure - typically pressure in excess of seven atmospheres or 103 PSI (pounds/square inch), but usually these injuries occur when people are searching for leaks with their fingers, so injuries of the hands are common.

Sometimes, the skin is in-line with, or just to the side of, a high-pressure nozzle.

Cases of high-pressure injection have been in the scientific literature since the 1920s, in addition to stories recounted in my training classes, so how such injuries have occurred has also included:

Accidental Mishandling Of Tools: An example would be a paint gun using too high of a pressure so it twists around in the hand and injects paint into the worker’s abdomen; Searching for leaks with the tongue; Listening for leaks, producing an injury into the side of the face; and A detached hydraulic hose whips around in the air and strikes the Worker’s body.

How serious is the injury?

When air/liquid/solids are injected into the skin, the injected material produces pressure on the blood vessels restricting or blocking local blood circulation.

The restricted blood flow can cause the skin, such as the finger tips beyond the point of injection, to appear white or mottled blue.

This is a deceptive injury - it usually begins as a tiny entry point with maybe a stinging sensation, leading the victim to think that this is not serious.  

As the swelling and inflammation develop, the pain becomes intense.

The result of delaying medical attention becomes quite serious as tissues are starved of oxygen and nutrients, infection can develop, and injected materials can migrate from the site of injury (even up into the arm). 

So, if you experience a high-pressure injection injury, you must seek medical attention immediately – a surgeon can open the injection site, decompress the tissues, clean out the injected material, and provide antibiotics to prevent infection.

Every effort should be made to evacuate the injected material at the earliest possible time.

Usually the trauma from air is less severe than from liquids.

Don’t delay medical attention - from the early onset to conclusion, the final outcome is highly dependent upon competent surgical treatment.

The case histories on this injury tend to indicate that few people will ever have a completely normal hand again.

Some victims have experienced nerve damage with stiff fingers.

In some cases, delaying treatment has led to gangrene requiring amputation of a fingertip.

Prevention is the key!

Gloves and clothing do not usually provide significant protection.

You need to address this hazard higher up on the hierarchy of controls by using engineering controls and administrative controls.

Does your workplace include maintenance on high-pressure lines or equipment as a part of its lockout/tagout program? - See the U.S. Occupational Safety & Health Administration (OSHA) Standard on Control of Hazardous Energy, 29 CFR 1910.147 

Your workplace program should include making sure that all pressure is bled/released from the hydraulic or pneumatic system.

For some systems it may be possible to work on a part of the system by using line-breaking or blanking procedures.

During maintenance, you will want to inspect all gauges for zero pressure and review the hydraulic/pneumatic schematic for pressure traps, such as accumulators, and check valves.

Some other examples of engineering and administrative controls may include reducing the pressure below 103 PSI, if possible.

This may be an option for pneumatics or for pressure washers, although probably not likely for hydraulics, which may need to operate at 1000s of PSI.

Use a low-pressure sensor or alarm so that a leak is known.

Does your workplace have a preventive maintenance program that includes inspecting hoses at regular intervals for wear?

If so, then hoses can be replaced before leaks can develop.

Use braided hoses which blister before leaking – so impending failure is obvious.

Never loosen or tighten a hydraulic connection when the system is under pressure.

The connection could fail catastrophically and cause an injection injury and/or damage to property.

And we all need awareness, as well as training on the hazard of high-pressure injection injury.

Provide immediate warnings and signage on the hazard of high-pressure injection injuries.

Now, does your workplace have work practices which forbid the use of the fingers to check for leaks or forbid any other of the leak testing situations described earlier that use the body as a test instrument?

Consider other methods of leak detection, such as submersion of a line under water or applying a soap solution to show bubbles.

Dyes added to a fluid may also help to identify the source of a leak.

And use barriers - any hydraulic lines and components that are exposed and routed near the equipment operator should be shielded to protect the operator.

Also avoid routing hose assemblies in areas where the ambient heat is excessive.

Heat may cause the hose to fail and potentially ignite an oil fire, injuring people or damaging equipment.

And, check the specifications for the correct temperature rating of the outer hose cover material and use a fire sleeve when necessary.