High Pressure Injection Injuries - Appropriate Caution & Control

I have only ever had one personal situation where a High Pressure Injection Injury was suspected. At 04:55am I was made aware by an extremely worried looking OIM that one of his crew was in the sick bay and he was growing increasingly concerned that they had not responded to treatment from the Medic over a 4 day period and he needed assistance to get the IP transferred onshore for an elevated assessment. The OIM and I made our way to the Sick Bay and as we entered and I caught my first glimpse of 'someone' laying in the bed...my genuine first impression was of someone looking 'malnourished'...overly thin and whom appeared almost incapable of even lifting their own arms through weakness...it was then I recognised exactly who this was laying in the bed and it was their condition that had prevented me from making the distinction that I should have...this person was clearly unwell.

Steps were taken to get the gentleman off the rig and to more appropriate medical attention and the necessary investigation began where it was made known that one of the crew had seen a 'rainbow type sheen' emanating from some equipment hydraulic hoses fitted to an Iron Roughneck located on the Rig Floor, and in an instinctive action, the Assistant Driller ran his hand through the sheen to assess its origin...the rest was history as we say. Looking at what causes the potential for personal interactions with harmful situations of this type I felt it was important to 'learn' as much as I could having only very briefly covered this subject matter during my NEBOSH in 1996 and since that date (some 10 years later) had had no personal requirements to know more other than of course precautionary practices...some personal and professional vulnerability there also. Although motivated now, what struck me then and has done so since was my memory of seeing that gentleman laying quite helplessly in that sick bay bed purely because of his lack of awareness toward the hazards that surrounded both he and his crew through the nature of their work activities. Since then I have always kept an open mind and elevated interest in the dangers of equipment pressures, hoses and conditions and exploited the knowledge of personnel who by virtue of their job role may have more interaction with such systems than I on a daily basis. I was recently updating a procedure that once again drew my mind across potential interactive opportunities between crews and pressurised equipment and as no surprise to me, my mind once again drifted to that eventful morning in the sick bay. For the purposes of peer procedure review I later had a reflective conversation with a HSE colleague and speculatively asked them what pressures they felt may be sufficient to be classed as having the potential to cause 'Injection type Injuries'...the answer they gave (and I mean no disrespect) somewhat surprised me. They considered my proposed 100psi (7 bar) as far less than should be indicated within the procedure I was developing and they felt more appropriately that 500 to 1,000psi should be prescribed...I realise that such knowledge is not necessarily as common as I believed it was or hoped it should be. Importantly on this point it is necessary to perhaps highlight that most High Pressure Injuries (HPI's) that have been reported and treated tend to come from Labourer regarded working activities where personnel are 'hands on' with equipment rather than passing adjacently to equipment systems that may have failed. Equipment systems may include paint spray guns, greasing gun systems, fuel injectors, air compressors, air line systems, hydraulic oil energised systems, many of which are prolific in many industrial, construction and engineering environments.

High-pressure injection injuries begin with an initial force being delivered to body tissue areas and can be delivered within ranges between (for example) 2,500 to 12,500psi and including velocities of up to 400mph. To provide some context, the kinetic injury of a grease gun incident to a finger is calculated to be equivalent to a 1000kg weight falling from a height of 25cm (or 9.8 inches) which is extremely concerning and I believe needs to be known to the potential users of such equipment.

Under several professional study reviews, the Mechanism of Injury that led to the personal damage (injuries) was found to depend predominantly upon the following:

The type, toxicity, temperature, and thickness of the fluid injected into the body and with examples of substances that may be injected included:

• Paint (60% of cases)

• Grease (25% of cases)

• Oil

• Diesel

• Paint thinner

• Water

• Air

• & Animal vaccines

  
  

Additionally;

• The amount of fluid that was injected

• The part of the body where the injection occurred

• The velocity at which the fluid was injected

• How long it takes to receive treatment after the injury occurs

• The extent of spread of the injected fluid into other tissue

Note: The materials considered most likely to cause complications are turpentine, paints, paint solvents, paint thinners and fuel (considered as organic solvents). Although Air and Water are not considered as potentially harmful if injected, patients or injured parties (IP's) should still be closely monitored for potential secondary complications.

Foreign Material Damage - When pressure penetrates the skin surface foreign materials can become propelled in a stream until they encounter resistance by way of muscle or bone and can disperse further. In some cases this can lead to tissue oedema (swelling) which puts extreme pressure on the surrounding blood vessels and hindering blood supplies of the affected area or in more extreme cases necrosis which is an irreversible decay of tissue if left untreated.

Necrosis tissue damage

Symptoms - Initially, patients may present with a numbness or feeling of pressure increase, however, the affected area may later become swollen, painful, tense, cold and pale. In all cases personnel who feel they may have had a negative interaction with pressure systems are recommended to report the occurrence and air on the side of caution.

Preventing High-Pressure Injection Injury in the Workplace

While we recognise that high pressure injection injuries are rare they do occur, these workplace injuries can be incredibly severe and costly. In these cases 'prevention is certainly better than cure' so it is critical for protecting our workforce where the use of high-powered equipment is expected and commonplace.

Below are a few of the most important practices and behaviors we can employ do to prevent this injury in your workplace:

• Ensure personnel are well trained and educated on the equipment they are expected to operate

• Utilise pre-use safety briefings to reiterate safe practices and reduce the risk of incidents and accidents

• Maintain equipment in accordance to the manufacturer recommendations at all times and change out any considered defective, worn or damaged fittings or hoses

• Promote and encourage a positive reporting culture among activity teams at all times...any injury types are to be notified

• Promote the correct use of equipment safety devices and conduct periodic checks to ensure compliance

• Raise awareness of safe practices with regular campaigns and information shares - Discourage leak testing and cleaning of equipment with fingers and hands or any other body parts

• Encourage safe isolation of equipment prior to any intrusive or maintenance work activities

• Establish safe demarcation and boundaries when operating pressurised equipment and lines

• Discourage 'horseplay' and poor operational techniques when utilising equipment

Risk Assess - Risk Assess - Risk Assess

Personal Protective Equipment

Select the appropriate PPE type and material and check with the equipment manufacturer's instructions and refer to the safety data sheets (SDS) for the substances planned for use. Hand protection is anticipated as typically mandatory, especially of a type that allow for adequate protection and do not sacrifice dexterity and grip. Depending on the solvent, chemical or medium being used, disposable gloves are often desirable, as these reduce the risk of cross-contamination. 

In addition to gloves, goggles, protective gowns, face shields, shoe covers are also frequently used and recommended when handling high-pressure equipment. To protect both the worker and the PPE itself, workers should be well-trained in the proper donning, doffing, and storage of these protective garments. 

As with all work activities adequate and appropriate Risk Assessment should be undertaken prior to commencing any work.

Risk Assess - Risk Assess - Risk Assess

Keep safe and well everyone and remember that 'safety is never a compromise'