Evaluation of the effect of skin cleaning procedures on the dermal absorption of chemicals

Optimizing Triage in Chemical Disasters: Validation of Modified IGSA Criteria for Hydrofluoric Acid Exposure

OBJECTIVE

This study aimed to develop and validate the modified irritant gas syndrome agent (IGSA) criteria, utilizing readily available triage information and epidemiologic data to efficiently segregate patients based on the severity of hydrofluoric acid (HFA) exposure.

METHODS

A retrospective analysis of 160 patients exposed to HFA was performed to develop the criteria and assess the criteria's efficacy, focusing on age, respiratory rate, and compliance with IGSA standards. The criteria's validity was assessed by comparing clinical outcomes between patients meeting the modified IGSA (mIGSA) criteria and those who did not as external and internal.

RESULTS

The mIGSA criteria (or AIR criteria) consisting of the 3 clusters of age greater than 49, IGSA criteria satisfied, and respiratory rate greater than 19 was developed. The area under curve of receiver operating characteristic curve for prediction of the risk of confirmed HFA injury according to AIR criteria was 0.8415 at the external validation.

CONCLUSIONS

The mIGSA criteria offer a significant improvement in the triage of HFA exposure incidents, facilitating rapid identification and prioritization of patients with potentially severe outcomes. Future research should aim to further validate these criteria across diverse emergency scenarios, reinforcing their utility in global health emergency preparedness.

Skin decontamination procedures against potential hazards substances exposure

Decontamination of unprotected skin areas is crucial to prevent excessive penetration of chemical contaminants after criminal or accidental release. A review of literature studies was performed to identify the available decontamination methods adopted to treat skin contamination after chemical, radiological and metal exposures. In this bibliographic review, an overview of the old and recent works on decontamination procedures followed in case of potential hazards substances contaminations with a comparison between these systems are provided. Almost all data from our 95 selected studies conducted in vitro and in vivo revealed that a rapid skin decontamination process is the most efficient way to reduce the risk of intoxication. The commonly-used or recommended conventional procedures are simple rinsing with water only or soapy water. However, this approach has some limitations because an easy removal by flushing may not be sufficient to decontaminate all chemical deposited on the skin, and skin absorption can be enhanced by the wash-in effect. Other liquid solutions or systems as adsorbent powders, mobilizing agents, chelation therapy are also applied as decontaminants, but till nowadays does not exist a decontamination method which can be adopted in all situations. Therefore, there is an urgent need to develop more efficient and successful decontaminating formulations.

Chemical mismanagement and skin burns among hospitalized and outpatient department patients

Purpose. This article attempts to elucidate the nature of chemicals causing major and minor skin burns, and their associated characterization across different industries, using Fujian provincial hospitals' admission and outpatient department records. Materials and methods. Data were collected from the provincial hospitals of Fujian through a questionnaire, sent via email, from June 1, 2017 to November 30, 2017. The collected responses were statistically analyzed using SPSS version 19 through the interquartile range, median, Mann-Whitney U test and Fisher's exact test with two-tailed significance. Results and conclusions. The results of 306 collected responses reveal that the majority of skin burn cases are due to a lack of technical education and professional training among workers handling chemicals. This study suggests that management's effective supervision and governmental regulations may help to prevent chemical skin burns at work, and can further be controlled by hiring professional workers alongside providing training to them in chemical handling as well as using protective equipment and developing appropriate management policies to improve victims' well-being and quality of life. Findings will help workers, doctors, hospitals, industries, government and other stakeholders to understand and control chemical hazards on site to minimize the risks of chemical skin burn incidents.

Exposure of amateur gardeners to pesticides via the non-gloved skin per day

To predict a risk to gardeners not wearing protective gloves, the dermal absorption of three active insecticides was assessed in vitro using porcine ear-skin simulating 1-h handling of diluted plant protection products. Acetamiprid and Pirimicarb were found in the receptor fluid immediately after 1-h skin exposure, whereas Chlorpyrifos-methyl absorbed in the skin was not released into the receptor fluid even after 23 hours. The Estimated Gardener Exposure Level (EGEL) at 23 hours after 1-h exposure for two worst-case scenarios (i) non-gloved hands; (ii) non-gloved hands/uncovered forearms, was (i) 0.002, 0.042, and 0.057; (ii) 0.006, 0.101, and 0.135 mg/kg bw/day for Acetamiprid, Pirimicarb, and Chlorpyrifos-methyl, respectively, although the systemically available Chlorpyrifos-methyl amount, due to retention in the skin, is probably lower than determined. The Gardener Exposure Risk (GER), as a ratio of Acceptable Operator Exposure Level (databased values) to EGEL, for Acetamiprid was (i) 35 and 12-fold higher than the limit 1, so the risk via the skin is assumed to be low. Based on the GER values of (i) 0.83 and 0.18; (ii) 0.34 and 0.07 (i.e.<1) for Pirimicarb and Chlorpyrifos-methyl, respectively there is a level of concern regarding the health risk to gardeners handling pesticide products without skin protection.

Dermal Uptake from Airborne Organics as an Important Route of Human Exposure to E-Waste Combustion Fumes

Skin absorption of gaseous organic contaminants is an important and relevant mechanism in human exposure to such contaminants, but has not been adequately examined. This article demonstrates that dermal uptake from airborne contaminants could be recognized as a significant exposure route for local residents subjecting to combustion fume from e-waste recycling activities. It is particularly true for organic pollutants which have high dermal penetration rates and large skin-air partition coefficients, such as low molecular weight plasticizers and flame retardants.

Early and Thorough Wound Debridement Is Crucial for Treatment of Patients With Thermal Burns and para-Chloronitrobenzene Poisoning

para-Chloronitrobenzene (p-CNB) is one of the important chemicals with high liposolubility and oxidizing properties. Heated p-CNB liquid can cause thermal injury by absorption over skin and wound and even methemoglobinemia by conversion of hemoglobin into methemoglobin. Severe methemoglobinemia is a life-threatening condition that demands immediate treatment. It is very rare for individuals to be injured by heated p-CNB, but they should be carefully attended to because of the peculiarities of this kind of injury. In the past 10 years, we received 5 patients who were injured by heated p-CNB. In addition to the intravenous administration of methylene blue, prompt and thorough wound management played a crucial role in the treatment of these critically ill patients, indicating the potential value of sufficient information for the clinical practitioners. The purpose of this article is to report our experience in the management of patients with thermal burns and p-CNB poisoning.

Ten-year epidemiology of chemical burns in western Zhejiang Province, China

BACKGROUND

Chemical burns occur frequently in western Zhejiang Province. This study documents the epidemiology of chemical burns in the region using burn data from a local specialized hospital. Results from this analysis will assist in the planning of prevention strategies for high-risk occupations and groups.

METHODS

A 10-year retrospective analysis was conducted for all patients with chemical burns admitted to the Department of Burn and Plastic Surgery from January 2004 to December 2013. Information obtained for each patient included demographics (gender, age, occupation and education), location of the burn, cause of the burn, and categories of chemicals. Data regarding the season of admittance, prehospital treatment, wound site/size (area, region, and depth), accompanying injuries, operations, length of hospital stay and mortality were also assessed.

RESULTS

A total of 690 patients (619 males, 71 females; average age: 30.6±12.4 years) were admitted to the department for chemical burns. Over the 10-year period, the incidence of chemical burns showed an increasing tendency. Chemical burns occurred most frequently in patients aged 20-59 years (94.79%). Most of the chemical burns were work-related, primarily in private enterprises (47.97%) and state-owned enterprises (24.93%). Operations (68.99%) and machine problems (17.26%) were the main causes of chemical burns in the workplace. With regard to burns caused by chemicals, most were caused by acids (72.01%), with hydrofluoric acid and sulphuric acid causing 51.45%. Most chemical burns occurred in the summer and autumn seasons (61.02%). The burn size was <10% of the total body surface area (TBSA) for 445 patients (64.49%), while only 26 patients (3.76%) had burns covering >40% TBSA. The most common burn sites were the upper extremities (31.57%), lower extremities (19.86%), and head and neck (28.83%). Most patients (581 (84.20%)) received water washing treatment on site immediately after exposure. The most common accompanying injuries included inhalation injury, ocular burns and digestive tract injury. The average hospital stay was 17.0±23.1 days (range 1-333 days). Surgery was performed in 146 patients (21.16%), and the overall mortality rate was 0.58%.

CONCLUSIONS

Chemical burns are preventable. The high morbidity of chemical burns in western Zhejiang Province is related to the industrial structure of the area. Governmental management in the fields of production, transportation, and utilization of chemicals could be improved. Workplaces have the responsibility to provide safe work environments and equipment, as well as occupational education and safety training for high-risk work groups.