Epidemiology of Work-Related Hydrofluoric Acid Exposure in Western Zhejiang Province, China

Abstract

Background: Hydrofluoric acid (HF) burns are one of the most frequent chemical burns in western Zhejiang province of China, and most of them are work-related. This study documents the epidemiology of HF burns in the region using burn data from a local specialized hospital. Results from this survey will assist in the planning of prevention strategies for high-risk occupations and groups. Methods: A 13 y retrospective analysis was conducted including all patients with work-related HF exposure admitted to the Department of Burns and Plastic Surgery, Zhejiang Quhua Hospital, Zhejiang Province, China, between January 2004 and December 2016. Information obtained from eligible patients included sex, age, education, season distribution, type and nature of enterprise, cause of HF injury, and HF concentration. Data regarding time lag from injury to medical treatment, burn sites and sizes, accompanying injuries, treatments, and prognosis were also assessed. Results: A total of 316 patients (294 males, 22 females; average age: 39.5 ± 10.31 y) were admitted for work-related HF burns. These patients were divided into the FI group (170 patients) and the NFI group (146 patients). The incidence of HF burn injury has increased gradually over the last 13 y period, although several slight fluctuations were observed in several years. There was a significant difference in education level between the FI and NFI groups. Compared to the state-owned enterprises, private enterprises seemed to contribute most of the work-related HF injuries. These HF injuries were caused by varying concentrations of HF solution. The average concentration of HF in the FI group was significantly higher than that in the NFI group. However, the time lag from injury to medical treatment in the FI group was shorter than that in the NFI group. The most common burn sites in the FI group were the head, neck, arms, and legs, while the hand was the most frequently involved site in the NFI group. The average burn area was significantly larger in the FI group than the NFI group. In terms of accompanying injuries, there were higher rates of morbidity in the FI group than the NFI group. Accordingly, the FI group showed a higher poisoning severity score than the NFI group. Fifty-two patients underwent surgery, including 31 from the NFI group and 21 from the FI group. Most of the surgeries involved early eschar excision and skin grafting performed in the ER, while most surgeries, including amputation and flaps, were performed in patients in the NFI group. More sequelae were observed in the NFI group. Conclusions: Work-related HF burns are preventable. The high morbidity of HF burns in western Zhejiang Province is related to the industrial structure of the area. The related enterprises and local authorities are encouraged to launch and upgrade their safety policies, as well as to provide the necessary occupational education and training to high-risk populations based on the differences in characteristics of the FI and NFI groups. Strategies focusing on the production, transportation, and usage of HF should be enhanced immediately.