Hydrofluoric acid burns in the western Zhejiang Province of China: a 10-year epidemiological study

Abstract

Background

Chemical burns caused by hydrofluoric acid (HF) frequently occur in the Western Zhejiang Province. This study aimed to investigate the epidemiological characteristics of HF burns within this region.

Methods

A 10-year retrospective analysis was conducted using data from all inpatients with HF burns. These patients were treated at the Department of Burns and Plastic Surgery at our hospital between January 2004 and December 2013. Information obtained for each patient included sex, age, occupation, burn location, burn cause, and the hazard category of the chemical which caused the burn. Data regarding wound site and size, accompanying injuries, serum electrolyte levels, operations, length of hospital stay, and mortality were also assessed.

Results

A total of 201 patients (189 males, 12 females; average age: 38.33 ± 10.57 years) were admitted due to HF burns. Over the 10-year period, the morbidity of HF burns in the past 10 years showed a gradual increase, which paralleled the development of local fluoride industries. Most HF injuries were work related and distributed in working-age patients. Aqueous HF solutions, especially highly concentrated ones, were the most common chemical cause of HF burns. Moreover, inappropriate operation, machine problems, and inadequate protection were identified as the leading causes of HF burns in the workplace. The burn area was <5% of TBSA in more than 90% of patients, and the most common burn sites were the head, neck, and upper extremities. Approximately 17% of patients underwent surgical operation. Accompanying injuries should be detected and treated correctly in a timely manner. Lastly, electrolyte imbalances, such as hypocalcaemia, hypomagnesaemia, and hypokalaemia, occurred frequently in patients with HF exposure; however, hyperkalaemia was not encountered in this study.

Conclusion

Based on the epidemiological results for HF burns in this region, the related enterprises and local authorities should be encouraged to upgrade management policies and to provide necessary occupational hazard education and safety training for high-risk occupations within high-risk working populations. Furthermore, the enhancement of hazardous chemicals management is also needed. Finally, for patients with HF exposure, early and correct pre-hospital triage, treatment and consequent in-hospital treatment and procedures should also be improved.

Conclusions

To summarise; this epidemiological study presents characteristic findings related to HF burns in western Zhejiang Province, China. Firstly, the morbidity of HF burns in the past 10 years showed a gradual increase, which can be attributed to the development of local fluoride industries. Secondly, most HF injuries were work related and distributed in working-age patients. Thirdly, aqueous HF solutions, especially those of high concentration, were the most common chemical cause of HF burns. Furthermore, inappropriate operation of equipment, machine malfunctions, and inadequate protection were identified as the leading causes of HF burns in the workplace. The burn area was <5% of TBSA in more than 90% of patients, and the most common burn sites were the head, neck, and upper extremities. Approximately 17% of patients underwent surgical operation. Accompanying injuries should be detected and treated correctly in a timely manner. Lastly, electrolyte imbalances, such as hypocalcaemia, hypomagnesaemia, and hypokalaemia, occurred frequently in patients with HF exposure; however, hyperkalaemia was not encountered in this study. Based on these results, related enterprises and local authorities should be encouraged to upgrade their management policies and to provide the necessary occupational education and safety training to high-risk populations. The local government would benefit from the establishment of a long-term strategic plan to improve education and to enhance the management of hazardous chemicals. Moreover, strategies focusing on the production, transportation, and usage of HF should be enhanced further for labourers and professionals dealing with chemicals, including consideration of the details of injuries caused by HF and other mixtures. Early and correct pre-hospital treatment, such as water irrigation and application of antidotes should also be considered for the effective management and immediate treatment of HF burns. Thus, the education of workers to provide common emergency knowledge and skills is highly warranted.

Declarations

Acknowledgements

Thanks to Dr. Ruiming Jiang, and Dr. Jia Liu, for their help in information collection and statistical analysis.

Funding

This work was financially supported by the Project of Zhejiang Science and technology (2015C37022), the Medical Health Platform Program of Zhejiang, China (2013ZD025) and the Zhejiang research project of commonweal technology (2017C33186).

Availability of data and materials

The data and material are available by contacting the author: Xingang Wang: e-mail: [email protected].

Authors' contributions

YZ and XW designed this survey; JZ, XJ, LN and CY collected the data; CH conducted the statistical analysis; XW and KS prepared the manuscript. All authors have reviewed and approved the final draft.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

No details on individuals are reported within the manuscript.

Ethics approval and consent to participate

The study was approved by Ethics Committee of Quhua Hospital.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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