Training of occupational health professionals

Chemical danger and hazard: Are training and knowledge of Occupational Health professionals adapted to their management?

Globally Harmonized System

More than 75000 corrosives, irritants or sensibilising products for the skin, eye or respiratory tracks are registered by the European Chemicals Agency (ECHA).

These registrations group together pure chemicals and commercial mixtures. Labelling criteria classification as well as packaging requirements of dangerous chemicals have been unified by the “Globally Harmonized System” (GHS) recommendations. This allows better identification of dangerous chemicals whatever their geographic origin. Furthermore, in Europe, a registration system has become mandatory for substances and mixtures before they are released on the market (REACH). The products are directly registered by manufacturers.

Following the recent reform of French occupational health organization, the number of occupational nurses has significantly increased due to the decrease of medical practitioners. Certainly, their specific training to practicing occupational health is almost compulsory but is it adapted today to field necessity and professionals’ needs? Are occupational nurses aware of the evolution of their missions? Do they have the new competences which will be needed more and more? Of course, the growing need for new skills becomes apparent for health professionals working in industry but it is just as necessary in hospitals and clinics where chemical hazards are also present.

If the need of an early washing wins unanimous support, there is no unified protocol for the management of a chemical injury, both in terms of delay or length of washing

Evaluation of international occupational health professionals

Two years ago, as chemical risk management specialists, we decided to evaluate the knowledge level of international occupational health professionals and raise awareness regarding identification of danger and evaluation of chemical risk as well as prevention at working place. Some of you have participated in this study. May I take this opportunity to thank all those who have collaborated on this project. Among survey respondents, 50% are from Europe. The other half comes from BRICs (Brazil, Russia, India and China), Africa, South America and Asia.

This conducted survey involved more than 400 medical doctors and nurses. The questions were grouped mostly into three topic areas:

• Time allotted during training to appreciation of danger and evaluation of chemical hazard
• Actual knowledge of occupational health professionals in this field
• Management of first aid when faced chemical injury.

The main results that raised our concern are as follows:

• The majority of occupational health professionals are concerned by chemical injuries (61.45% of survey respondents are confronted at a monthly frequency)
  82% of surveyed professionals do make a distinction between emergency management of chemical injuries compared to thermal burns.
• If the need of an early washing wins unanimous support, there is no unified protocol for the management of a chemical injury, both in terms of delay or length of washing. In this survey, water, traditional first aid decontamination solution, remains by far the preferred solution (55% of washings).
• These results show the importance and the scale of the problem which deserve special attention so as to put forward ideas and propose options for the future.

At the same time, some interesting questions arise from the results. First, the very definition of a chemical injury is insufficiently understood by occupational health professionals (as for the nature, aspect, depth, extent, evolution prognosis…).

The ignorance of the complexity of parameters of chemical injuries does not facilitate their initial evaluation or the specificity of the initial and secondary management.

The number of professionals who are regularly confronted with chemical injuries and demand for training adapted to their needs are also issues which deserve further consideration. 20% of survey respondents wish to enhance their knowledge on chemical hazard; 56% think that they do not have enough knowledge about risks and victims’ management. Sufficient washing time is also quite variable, 29% think it is less than 5 minutes.

Those last results highlight the need to train and educate a wider public on first aid and good practice concerning chemical injuries

An improved analysis of professionals’ needs

However, to the question: “Within what timeframe a worker victim of a chemical injury is taken care of and by whom?” 55% of respondents state that this period is shorter than 5 minutes. Only 28% of victims are looked after by a medical practitioner or a nurse. 38% are taken care of by the closest colleague. Those last results highlight the need to train and educate a wider public on first aid and good practice concerning chemical injuries. We know, mainly thanks to in vivo studies, that an intervention time in the first minute is vital. Acids’ diffusion through the first layers of the tissues is very fast but there is however during the first hours a lapse of time during which an active delayed washing can still bring a significant benefit.

Certainly, this study gives better understanding and allows an improved analysis of professionals’ needs concerning chemical risk management through time allotted during training and from t heir specific knowledge on the subject. But it also and mainly focusses reflexion towards chemical risk management as a whole.

Indeed, we can also raise the question regarding occupational health professionals practice’s evolution. Today’s recommendations focus on the promotion of practice based on clinical evidence which highlight valid medical arguments. European and American standards recommend washing in the 10 first seconds, but this requires having thought of the overall decontamination concept: efficacy, ergonomics, and speed of implementation.

We all have buried at the bottom of our drawers such data, that we have more or less forgotten or minimized their importance. I remember, when I was a young OH nurse, having been faced with a serious work accident: concentrated ammonia projection in the eyes of a 35-year-old woman. She screamed with pain and was blinded immediately. She presented multiple ulcerations on the surface of both eyes. Diphoterine® solution had been used after more than three minutes of exposure. The pain diminished very fast. The young woman was driven to the regional hospital emergency unit. The ophthalmologist who performed the clinical examination was surprised by the limitation of the injury to the superficial layers of the cornea. The victim was out of work for only 9 days and kept no sequelae on the eyes. This case has been published. Since then, hundreds of cases of Diphoterine® solutions’s use on chemical injuries have been published; from isolated case report, series to industrial or hospital clinical trials; we could qualify them as happy endings compared to chemical accidents which not only leave sequelae but destroy faces and lives.

It is always more interesting and rewarding to share happy endings which allow sharing and progression. We therefore hope that this survey in which you might have participated raises your concern on clinical cases that you have encounted as OH physicians or nurses. But maybe have you had other experience concerning information or training that was sufficient or insufficient. You might also have been confronted to other cases of ocular chemical splashes. This information can help to refine this preliminary study we have performed due to all prevention employees’ contribution. Thank you for sharing your experience with us.

Janine Bigaignon, Occupational Nurse