Investigation Of Common Burn Mechanisms, And Training And Safety Conditions In The Workplace

Summary

Workplace burn injuries are associated with significant physical, psychological, and social challenges. This study was designed and conducted to investigate the common burn mechanisms, and training and safety conditions in the workplace. The study is a cross-sectional study that was performed on patients admitted to Shahid Motahari University Hospital in Tehran from August 2016 to October 2017. Samples consisted of patients who suffered burns at work and were able to answer research questions. Data were recorded in tablets by electronic patient registration forms.Of the total burn patients under study, 14.28% were injured in the workplace. The burns were mainly thermal, followed by electrical, chemical, and inhalation burns. 38.2% of patients were not trained for safety measures at work and 27.8% of patients were not given personal protective equipment. 39.0% of workspaces were not safe against the risk of burns. Failure of devices and equipment was the cause of 28.8% of the accidents. Electrical damage, the ignition of flammable materials, gas explosions and contact with molten materials were the most common mechanisms in the occurrence of workplace burns. The lack of awareness by workers, lack of attention to the use of safety equipment at work, and the presence of damaged equipment are the main causes of burn accidents in the workplace. Therefore, the implementation of codified safety training and monitoring the observance of safety measures by workers and employers are recommended.

Introduction

Burns were the fourth cause of death in the world in 2004, higher than tuberculosis and HIV. Injuries caused by burns are still one of the most important public health problems worldwide, especially in developing countries.¹ Burns are one of the costliest health issues; they cost about $54,000 per patient in the United States. Furthermore, workplace burns account for a quarter of burns in the United States.²

More than 350,000 workers die each year due to unintended occupational injuries worldwide.³ Injuries caused by work or accidents that occur during the period of employment are the main source of human suffering and economic losses. The International Labor Organization estimates that 153 workers worldwide suffer a work-related injury every 15 seconds. Moreover, work-related injuries in Australia were estimated to cost approximately $62 billion during the 2012-2013 fiscal year, accounting for approximately 4% of the national GDP.⁴ Between 1999 and 2002, 5,810 litigation cases were reported by burn workers over the four-year period in Virginia. This was estimated to be 4.3 burns per 10,000 workers. Total claim costs averaged $11,705,939 per year and $8,059 per claim.⁵ Statistics provided by the U.S. Department of Health and Safety show that work-related fires account for 5,000 burns per year. The country’s deadly occupational accident census reported 617 deaths in 2007, 10% of which were caused by fire and a significant percentage by electric shocks.⁶ Burn accidents are the cause of some of the most destructive work injuries. Depending on the severity of the accident, burn survivors may experience long periods of painful treatment and rehabilitation, physical and psychological complications, and experience numerous obstacles and challenges in returning to work. Although many burn survivors achieve a satisfactory quality of life, 30% of patients consistently report moderate to severe psychological and social problems.⁷ Patients who were injured in the workplace identified three categories of challenges: 1) Physical, cognitive, and mental disorders that affect their performance in the workplace. 2) Feelings of guilt, blame, and responsibility for the injury. 3) Being forced to return to the workplace where they were injured.⁸ In a 10-year study (2005-2014) in Korea, post-traumatic stress disorder (17.0%), nonspecific major depressive disorder (14.9%), severe major depression (9.3%), and adjustment disorders (9.1%) were the most common psychiatric disorders reported following occupational burns.⁹ Furthermore, some studies have shown that psychological symptoms after work-related injuries can complicate social participation, including returning to work. A bi-centric study found that 66% and 90% of patients returned to work within 6 and 24 months, respectively. One of these centers found that only 37% of patients returned to the same job, with the same employer and without residence, indicating the significant impact of workplace burns.⁷ The results of some studies have shown that 28% of burn accident survivors have never returned to their previous job.10Workplace burns are a major threat to individuals, families and communities. Despite countless measures and guidelines, occupational burns still account for a significant number of total burns.⁶ Identifying high-risk jobs and workspaces, rooting out the common causes and mechanisms of the accident, and examining the safety status of work environments are important steps in the design and implementation of preventive measures. Therefore, the present study was designed and conducted to investigate the common burn mechanisms, and training and safety conditions in the workplace.

Materials and methods

This study is part of a larger cross-sectional study that was performed on all patients admitted to Shahid Motahari University Hospital in Tehran, from August 2016 to October 2017. In order to evaluate patients with burn injuries in the workplace, data related to people with burn injuries in the workplace, who were able to answer the study questions, were analyzed.

Data collection

Initially, the questions were evaluated as a pilot on 100 patients in the form of a paper form, after approval and validation by experts. Preliminary data were extracted and after corrections, the electronic question form was designed in Kobocollect software. Questions in the four areas of demographic characteristics, information about burns, occupational status, safety, education, and exact causes and mechanism of the accident were completed offline, through the use of interviews and medical records of patients, and then sent online to the user page on Kobocollect. To extract the underlying causes of occupational burns, the mechanisms were classified into 15 categories and the description of the events reported by the patient was placed in each of these categories.

Data analysis

In order to analyze the data, the assumption that the data is normal must first be examined. For this purpose, the Kolmogorov-Smirnov test was used at a significance level of 0.05. Due to the rejection of the assumption that the data were normal, the Kruskal-Wallis test was used to compare the means. Data were analyzed using SPSS v21 software.

Ethical considerations

The plan was approved by the Ethics Committee of Iran University of Medical Sciences and received the ethics code IR.IUMS.REC 1394.26538. Oral consent was obtained from the patients and their parents before the interview.

Results

Demographic characteristics

Among 1708 patients studied, 243 cases of accidents occurred in the workplace (14.28%). The mean age of this group of patients was 33.11±24.44 years and most of them were married (67.2%), and in the age group of 19 to 39 years (68.3%). 239 (98.0%) of the patients were male and only five (2.0%) were female. 15.6% were non-Iranian and mostly Afghan. Most of the patients had diplomalevel or lower education and 14.9% were illiterate. The number of people living together in the same space was often five or less (77.4%), and the average monthly cost of patients was 1,500,000 Tomans (352 Euros or $375) per four household members. 23.4% of the patients did not have basic insurance coverage and only 14.4% had supplementary insurance (Table I).

Table I. Demographics of workplace burns.

Burn characteristics

The results showed that a significant percentage of patients had a previous burn injury and were outpatients (25 patients, 10.2% of the analyzed patients) or hospitalized (3 patients, 1.2% of the analyzed patients) due to their previous encounters with burns. Workplace burns were primarily accidental (238 cases, 97.5% of the total cases) and only a small percentage were due to incidents, such as self-immolation (2 cases, 0.8% of the total cases) or incidental burning by others (4 cases, 1.6% of the total cases). The findings also showed that the burns were mostly thermal and electrical, chemical and inhalation burns were in the next categories, respectively. Flames were the most common cause of thermal burns and were primarily caused by gas explosions. Furthermore, contact burns, which were the second most common type of thermal burns, were often caused by contact with molten materials. Following thermal burns, electrical burns made up the second most significant percentage of burns. They were mostly observed as both electrical and thermal (sparks). The median extent of burns in the studied patients was 10%, with a range from 1% to 65%. The burns were mainly superficial second degree (177 burns, 82.7% of total burns), third degree (152 burns, 71.0% of total burns) and deep second degree (94 burns, 43.9% of total burns). The highest extent of burns was seen in accidents involving flames. Conversely, the lowest extent of burns was seen in contact burns. The workplace accidents typically took place during the spring (65 accidents, 29.1% of total accidents) and summer (63 accidents, 28.3% of total accidents). Furthermore, most of the burns occurred between eight in the morning and three in the afternoon, especially at ten in the morning and three in the afternoon. Moreover, the face (142 burns, 58.2% of total burns) and the upper limbs (135 burns, 55.3% of total burns) were the most injured areas in workplace burns (Table II).

Table II. Types and causes of burn accidents in the workplace.

Occupational-safety-training conditions

Among the various occupations, casting and working with molten materials, bitumen and isogum (15.6% of total cases), working with electricity (10.4% of total cases), turning, forging, and welding (7.6% of total cases), cooking and serving food (7.2% of total cases), and working in construction (6.4% of total cases) were occupations where burns were more common. When analyzing the tools and equipment that patients had an accident with, the results showed that gas-burning equipment (35 cases, 14.34% of total cases), high-pressure electricity (34 cases, 13.93% of total cases), and injection machines and furnaces for melting material (26 cases, 10.65% of total cases) were the most common equipment that caused workplace burns (Table I). When asked about the state of education and safety at work, it was found that 38.2% of patients were not trained for safety procedures at work, 27.8% of them were not given personal protective equipment, 13.0% of the safety equipment was damaged, and 13.5% of workers did not use safety equipment regularly. Also, 39.0% of workspaces were not safe against the risk of burns. Moreover, failure of devices and equipment caused 28.8% of the total accidents (Table III).

Table III. Assessing training and safety at work.

Causes and mechanisms of burns

This study showed that electric shocks, especially metal devices colliding with overhead power lines, flammable materials, gas explosions and contact with molten materials, are the most common mechanisms in the occurrence of workplace burns (Table IV).

Table IV. The most common burn mechanisms in workplace burns.

Discussion

Workplace burns have unpleasant physical, psychological, social and economic consequences for the patient, family and community. The first step in designing preventive measures is to identify the epidemiology and etiology of occupational burns and to assess the state of education and safety in highrisk occupational settings. To achieve this goal, this study has presented useful results in preventing accidents and making workplaces safer.

Demographic characteristics

This study showed that 14.28% of all burn accidents occurred in the workplace. Various studies have reported different statistics for the percentage of burns in the workplace, such as 17% in New Zealand and Australia,⁴ 15% in the United States6 and 23% in Canada.² The results also showed that young men in the age group of 19 to 39 years were more likely to suffer from burns in the workplace. Most of them had a diploma-level or lower education and a significant percentage were not formally educated. Other studies in other parts of the world have identified young male workers as the most common victims of workplace burns.^4,10 In a 10-year study, Ortiz and colleagues in Ecuador found that education was associated with the severity of burns. So, in the study population, people with a university degree had less severe burns and shorter hospital stays.¹¹

In our study, 23.4% of patients did not have basic insurance coverage and 15.6% had non-Iranian citizenship. However, Mian and colleagues at a US university burn center reported that only 3.78% of patients did not have health insurance coverage.⁶ Our results show the lack of attention of employers and business owners to the welfare and insurance of workers, and the growing tendency to use cheap foreign labor to reduce payment costs.

Burn characteristics

The findings of the present study indicated that workplace burns were often caused by flames and contact. These types of burn are usually caused by the explosion of gas and contact with molten material, respectively. Following thermal burns, electrical damage also made up a significant percentage of burns in this study. A study conducted in 17 specialized burn centers in New Zealand and Australia during 2009-2016 found that flames were also the most common cause of occupational burns and the ratio of chemical burns, burns caused by hot liquids and electrical burns in workplace accidents, compared to non-workplace accidents, was higher. Also, most contact burns were caused by contact with hot metal, molten plastic, or adhesives and bitumen.⁴ A 10-year retrospective study of Canadian burn clients also identified flame, electricity and hot liquids as the most common mechanisms of occupational burns.²

The median extent of burns in our study was 10% with a range from 1% to 65%. Furthermore, most of the burns in our study were superficial second-degree burns or third-degree burns. In addition, the face and upper limbs were the most commonly affected areas in this study, which corresponded to the prevalence of accidents caused by flame, contact, and electricity. In a study by Reichard and his colleagues in US burn emergency centers, where thermal and electrical burns were more common types of burns, the hands and fingers, followed by the eyes, were the most common areas of injury.¹² In a study by McInnes in Australia, the extent of burns was reported to be less than 10%, often deep second-degree and full thickness. The upper limbs, hands, lower limbs and face were the most common burn areas. Due to the prevalence of flames in the occurrence of burn accidents in the McInnes study, this shows that the results were similar to our study.⁴

Occupational-safety-training conditions

This study found that casting and working with molten materials, bitumen and isogum, working with electricity, turning, forging and welding, cooking and serving food, and building construction were occupations in which burns were more common. Also, gasburning equipment, high-pressure electricity, plastic injection molding machines and molten material furnaces were the most common equipment that workers suffered burns from. A study by Carrougher in the United States, in line with our research, reported service occupations such as food and beverage preparation, health care and protection services, and construction jobs, including electrical technician, roof maker, metalworker and plumber as the occupations in which most occupational burns occurred.¹⁰ In Ecuador, construction workers, industrial mechanics and electrical technicians had the most occupational burn injuries.¹¹ In Canada, young people in the food, beverage and construction professions were more likely to suffer from burns.¹³ In several studies conducted in Iran, construction workers were identified as the most common victims of occupational burn injuries, and construction workshops and factories were the most common site of electrical damage.^14,15

Causes and mechanisms of burns

In this study, a significant percentage of patients did not receive safety training at work and were not given personal protective equipment or did not use safety equipment regularly. Furthermore, some work environments were not safe from the risk of burns, and in some cases, defects in equipment caused the accidents. The findings of a previous study on patients with electrical injuries in Iran also showed that nearly 60% of workers and electrical technicians were unaware of the dangers they may face when working with electrical appliances.¹⁴ Electric shock victims in Sweden also stated that despite all people having access to the right tools, fewer than 40% of them used safety equipment. Most of them were familiar with their work environment and duties, but sometimes personal factors interfered with the work, and the haste and tightness of time prevented them from stopping work.¹⁶ Findings obtained in the United States also stated that inexperience, non-compliance with safety regulations, inadequate training of workers, and the non-compliance of workers were significant factors in the occurrence of occupational burns.⁶ Our study, similar to studies in other parts of the world, determined that the lack of safety training for workers, negligence in the use of safety equipment at work and lack of control and supervision of employers on the safety conditions of workspaces, equipment conditions, and performance of workers are the main causes of burn injuries in the workplace.

Limitations

In this study, only hospitalized patients who were able to answer the questions were examined. Therefore, the non-participation of outpatients and inpatients in the intensive care unit who were unable to interview significantly reduced the study population. The lack of information in some medical records was another limitation that was encountered in this study.

Conclusion

This study showed that electric shocks, especially metal devices colliding with the overhead wire of high voltage power carriers, flammable materials igniting, gas explosion and contact with molten materials were the most common causes of workplace burn accidents. Also, workers’ unfamiliarity with the dangers of their occupation, lack of personal safety equipment, underutilizing safety equipment, and the breakdown of equipment and devices play an important role in the occurrence of workplace burns. Therefore, paying more attention to high-risk jobs, conducting safety training seminars, and monitoring the observance of safety regulations by workers and employers are key points in preventing and reducing burn injuries in the workplace.