In the world of “safety” the focus quite rightly tends to be on the prevention of major accidents and fatalities, but in doing so, we tend to lose sight of the very large number of non-fatal occupational injuries many of which have life changing consequences. This is not limited to purely “safety” related events, we have known for many years that occupational health injuries fit into exactly the same category.
Hand injuries are one of these injuries which can sometimes be considered by lay people as less “serious” and yet for the people involved and their relatives the consequences often can be devastating.
I can recall speaking to one colleague who had crushed his right thumb (he was right-handed), an injury that in time he would fully recover from, on what impact it had on him. He said that he was shocked at the huge range of tasks he was no longer able to do. He stated that it dawned on him just how much he took his fingers and thumbs for granted. Examples he gave were simple things like tying his shoelaces, signing his name (he could not hold a pen) and worst of all from his perspective, he needed help when he went to the toilet.
I think many of us, myself included, would admit that we also take our fingers, thumbs, hands and arms for granted. We seldom stop to think about what life might be like if we could not use them or had limited use. But let’s put this in perspective, how significant are hand and arm injuries? In 2018, the U.S. Bureau of Labor reported that of the 286,810 non-fatal occupational injuries to upper extremities involving days away from work in private industry, 123,990 involved hands, which is more than 43 percent. Looking at reported statistics through the EU, Canada and Australasia, the percentages are broadly similar. It is clear then that hand and finger injuries are very prevalent in the workplace. The frustrating issue here is that the consequences of hand and finger injuries can be life changing, but at the same time are often easily prevented.
So, let’s take a look at the type of injuries that may occur:
- Burns (chemical, radioactivity and heat)
- Repetitive strain injury
- De-gloving (where the skin is pulled off the bone)
We will look at these various hazards, how they occur, and what can be done to either eliminate them or minimise the risk of injury.
Vibration White Finger
This condition has been around for a very long time, but it was not very well understood. It has only been in the last 30 years that details of the hazards and health-related consequences have been identified. The vibration is transmitted from work processes into workers’ hands and arms. It can be caused by operating hand-held power tools such as road breakers, hand-guided equipment such as lawn mowers, or by holding materials being processed by machines such as pedestal grinders. Prolonged and regular exposure to this vibration can affect the operator’s health, resulting in painful and disabling disorders of the nerves, blood supply, joints and muscles of the hands and arms. These disorders are collectively known as hand-arm vibration syndrome.
Work related upper limb disorders, continuous repetitive actions on the hands, wrists and arms can lead to reduced functionality of the hands and arms. Many workers experience this while at work. In many cases, the symptoms can continue out of the workplace and lead to daily discomfort and often long-term effects. This condition became particularly prevalent with the introduction of assembly lines and mass production, where workers would be expected to perform a specific task repetitively. People would typically turn to their left, collect a piece of equipment, return to a central location, perform a task and then turn to their right to release the work piece to someone else. This repetitive turning, especially from a seated position was extremely tiring and wearing on the individual and eventually led to significant spinal and muscular injuries. Think of how supermarket cashiers work. They are required to grab food products, scan them and then release them, constantly turning from a seated position.
This condition has more recently manifested itself in relation to the use of Display Screen Equipment. There are many billions of people today who spend long periods of time typing onto a keyboard whilst looking at a screen, and poor posture and poor typing skills are having a profound effect on the general wellbeing of many in the population.
Dermatitis, Skin Absorption, Sensitisation etc.
Dermal exposure is a major route of occupational exposure to hazardous substances. Different chemicals have different adverse effects on the hands and arms, from mild irritation, to contact dermatitis or corrosive burns. A large proportion of the workforce may be exposed to both naturally occurring and man-made chemicals while at work. Without adequate risk assessment and controls the results of this exposure can be detrimental.
Thermal burns are caused by working with hot surfaces, hot liquids, vapours, gases or heating systems. Similarly with extreme cold environments, workers can be exposed regularly to temperatures in the range of -20 to -50°C. One example might be workers who work in cold storage of meats, where the workers are required to spend significant amounts of time in the meat freezer. Consider also people working in colder geographical locations like Alaska or Northern Siberia. Both have extensive oil and gas industries and as a result many tens of thousands of people exposed each winter. The oil workers are often required to perform tasks requiring significant dexterity whilst outside and this can negate the use of protective gloves. If the dexterous task cannot be performed whilst wearing gloves, then the operators will take them off and thus exposing them to frost nip and frost bite. Exposure to extreme heat or extreme cold can both cause harm to hands and arms in the form of burns.
Lacerations, cuts and entanglement. Using mechanical equipment in the workplace can easily lead to cuts and abrasions if the correct precautions are not taken. In more severe cases, ﬁngers or even limbs can get caught in equipment, leading to entanglement and even amputation. Industries most affected by this are agriculture, construction and engineering.
These can be associated with several different industries but most commonly in the fields of medicine (nursing), veterinary medicine and animal farming. Needle stick injuries can be particularly harmful as often it is not just pain of being “stuck” by a needle, but of course the risk of being contaminated either by the material that was in the needle or potentially contaminants in the blood of the person or animal injected.
Hand and Arm Protection
To understand the importance of hand and arm protection, it is worthwhile to spend a few minutes considering the impact of what happens when the protection is not in place. I can recall several incidents during the course of my career where people have received awful and sometimes life changing injuries as a result.
My first example occurred in an offshore oil and gas facility; my colleague was working to prepare some downhole tools for a deployment later that night. He was supposed to be wearing protective gloves but opted not to as he did not think it was necessary. He was working to ensure the functionality of a mechanical setting tool. This involved metallic elements “sliding” over one another to properly set the tools required for a cementing job. He had the tool set up in a vice and was practicing running the setting tool, but he was concerned that it was “sticking”. This could have been catastrophic to the job and potentially could have cost thousands of dollars if it had been deployed downhole and did not function, so he was most anxious to make sure it worked. He started to use more force to move it backward and forward and during one of these movements his thumb got trapped in the tool. He was in agony and it took a full 30 minutes to free his thumb. The thumb was badly crushed and the team had no choice but to medivac him back to hospital onshore. The hospital operated on him that evening. I recall meeting him the next day as he emotionally described how he burst into tears when the hospital staff tried to remove his damaged nail. It took months of rehabilitation before he was able to return to work.
My second case involves a cement burn, my colleague was assisting to pour cement on a formwork construction job. In this case, my colleague was wearing gloves and was using a vibrating tool to ensure the wet cement fully filled all the voids. Unbeknown to him at the time, as he moved the tool around in the wet cement, some cement had run into his gloves. He did not notice and continued to work on. It was only when he took his gloves off that he realised that his hands and fingers had been badly burned by the cement, which can have a PH value of 9/10. Again, the process of recovery was very slow and even today, many years later, he still has permanent scars and discolouring on his hands.
My last example concerns a colleague who was using a foam spray in a confined space to fill voids in a well cellar. The spray contained a flammable gas as its carrier. Again, he noticed that the spray had a pungent smell but did not understand the hazard, he was working with a colleague who was holding a temporary light, 240v on an extension from the survey. At some point a flammable concentration built up and eventually ignited from the temporary light. There was an immediate flash fire, it lasted no more than a few seconds. Thankfully, most of his body was protected by coveralls, face mask, hard hat and boots, but unfortunately, he was not wearing gloves, and as a result he suffered third degree burns to both his hands. Sadly, in this case he required several skin graft operations to try and recover his hands. It was a long, slow and very painful experience. Unfortunately, he has very poor functionality in both hands and is unable to carry on working, nor to enjoy his special hobby, snooker, as he is unable to play. It was a truly life changing accident.
All three cases highlight just how important hand and arm protection can be. PPE is always the last layer of protection and proper risk assessment must be applied, but PPE must always be considered as it is often the last “barrier” to serious injury. Of course, as in all cases of effective health and safety management we will follow our hierarchy of control to identify hazards and then try to eliminate them, substitute them, introduce engineering controls, introduce administrative controls and finally provide personal protective equipment. For the purposes of this article, we are going to assume that all possible controls have been applied and that there is still some residual risk that will need to be managed through the use of PPE. So, let’s look at the different types of PPE that are available.
The main PPE used to protect hands and arms is gloves. There are a number of European Standards that govern the production of gloves, such as EN 420:2003, which outlines the general requirements for protective gloves, and EN ISO 10819:1997, which covers gloves marketed in Europe as ‘anti-vibration’. The latter must carry the CE mark, indicating that the gloves have been tested and found to meet the requirements of the current standard.
The standards also include gloves that give protection from:
• Chemicals and microorganisms – EN374:2003
• Mechanical risks – EN388:2003
• Thermal hazards – EN407:2004
• Cold – EN511:2006
• Radioactive contamination and ionizing radiation – EN421:2010
Types of Protective Glove
There are many types of gloves available today to protect against a wide variety of hazards. The nature of the hazard and the operation involved will affect the selection of gloves. The wide variety of potential occupational hand injuries makes selecting the right pair of gloves challenging.
Leather, Canvas or Metal Mesh Gloves
Sturdy gloves made from metal mesh, leather, or canvas provide protection against cuts and burns. Leather or canvas gloves also protect against sustained heat, against sparks, moderate heat, blows, chips and rough objects.
Aluminised gloves provide reflective and insulating protection against heat and require an insert made of synthetic materials to protect against heat and cold.
Aramid fibre gloves protect against heat and cold, are cut and abrasive resistant, and wear well.
Chain mail gloves, used particularly in the meat industry by butchers to protect their hands from knife lacerations.
Synthetic gloves of various materials offer protection against heat and cold, are cut and abrasive resistant, and may withstand some diluted acids. These materials do not stand up against alkalis and solvents.
Fabric and Coated Fabric Gloves
Fabric and coated fabric gloves are made of cotton or other fabric to provide varying degrees of protection.
Fabric gloves protect against dirt, slivers, chafing and abrasions. They do not provide sufficient protection for use with rough, sharp or heavy materials. Adding a plastic coating will strengthen some fabric gloves.
Coated fabric gloves are normally made from cotton flannel with napping on one side. By coating the un-napped side with plastic, fabric gloves are transformed into general-purpose hand protection offering slip-resistant qualities. These gloves are used for tasks ranging from handling bricks and wire to chemical laboratory containers. When selecting gloves to protect against chemical exposure hazards, always check with the manufacturer or review the manufacturer’s product literature to determine the gloves’ effectiveness against specific workplace chemicals and conditions.
Chemical and Liquid Resistant Gloves
Chemical-resistant gloves are made with different kinds of rubber: natural, butyl, neoprene, nitrile and fluorocarbon (Viton); or various kinds of plastic: polyvinyl chloride (PVC), polyvinyl alcohol and polyethylene. These materials can be blended or laminated for better performance. As a general rule, the thicker the glove material the greater the chemical resistance, but thick gloves may impair grip and dexterity, having a negative impact on safety.
Some examples of chemical-resistant gloves include:
- Butyl gloves are made of a synthetic rubber and protect against a wide variety of chemicals
- Natural (latex) rubber gloves are comfortable to wear, which makes them a popular general-purpose glove
- Neoprene gloves are made of synthetic rubber and offer good pliability, finger dexterity, high density and tear resistance
- Nitrile gloves are made of a copolymer and provide protection from chlorinated solvents such as trichloroethylene and perchloroethylene
Insulating Rubber Gloves
These gloves are used for protection against electrical hazards. They are classified by the level of voltage and protection they provide.
Glove Selection Factors
There are several factors besides glove material to consider when selecting the appropriate glove. The amount of dexterity needed to perform a particular manipulation must be weighed against the glove material recommended for maximum chemical resistance. In some cases, particularly when working with delicate objects where fine dexterity is crucial, a bulky glove may actually be more of a hazard.
Where fine dexterity is needed, consider double gloving with a less compatible material, immediately removing and replacing the outer glove if there are any signs of contamination. In some cases, it may be possible to wear a tight-fitting glove over the loose glove to increase the overall dexterity.
Usually, it’s measured in mils or gauge. A 10-gauge glove is equivalent to 10 mils or 0.01 inches. Thinner, lighter gloves offer better touch sensitivity and flexibility, but may provide shorter breakthrough times. Generally, doubling the thickness of the glove quadruples the breakthrough time.
It should be chosen based on the depth to which the arm will be immersed or where chemical splash is likely. Gloves longer than 14 inches provide extra protection against splash or immersion.
One size does not fit all. Gloves that are too tight tend to cause fatigue, while gloves that are too loose will have loose finger ends, which make work more difficult. The circumference of the hand, measured in inches, is roughly equivalent to the reported glove size. Moreover, glove colour, cuff design, and lining should also be considered for some tasks.
Caring for your Gloves
Protective gloves should be inspected before each use to ensure that they are not torn, punctured or made ineffective in any way. A visual inspection will help detect cuts or tears, but a more thorough inspection by filling the gloves with water and tightly rolling the cuff towards the fingers will help reveal any pinhole leaks. Gloves that are discoloured or stiff may also indicate deficiencies caused by excessive use or degradation from chemical exposure.
Any gloves with impaired protective ability should be discarded and replaced. Reuse of chemical-resistant gloves should be evaluated carefully, taking into consideration the absorptive qualities of the gloves. A decision to reuse chemically exposed gloves should take into consideration the toxicity of the chemicals involved and factors such as duration of exposure, storage and temperature.
Disposable gloves should be changed when there is any sign of contamination. Reusable gloves should be washed frequently if used for an extended period of time. However, follow the manufacturer’s instructions for washing and caring for reusable gloves.
The take home message is that hand and arm injuries are sadly extremely common, and the consequences can be life changing. But the good news is that hand and arm injuries can be prevented and mitigated against, if appropriate precautions are taken. If we are unable to engineer out the hazards, then we need to look at PPE to mitigate any exposure. Safety gloves in their various forms, such as non-slip cotton and cut and puncture resistant, are essential PPE. Gloves will reduce the risk of laceration, abrasion and puncture injuries, which based on injury statistics account for about 70% of hand injuries.