Epidemiology of domestic chemical burns in Saudi Arabia

Community-Level Awareness of Proper Immediate Steps for Ocular Chemical Injury in Saudi Arabia

BACKGROUND

The human eyes are the most vital sensory organ. Eye injury is the main factor leading to monocular blindness. There is a lack of understanding in the Saudi community regarding the appropriate response to a chemical injury to the eyes. To provide accurate and clear medical information about ocular chemical damage, it is crucial to identify areas where healthcare professionals fall short. To address the gaps in critical knowledge, this study aimed to focus on the Saudi Arabian community to determine if healthcare professionals have fulfilled their responsibility as health promoters in providing education on eye emergencies. We examined the immediate reaction of the study participants to evaluate the community's awareness of chemical eye injuries and immediate management strategies.

OBJECTIVES

This study aimed to assess and evaluate the general population's knowledge and awareness of immediate management steps following an ocular chemical injury in Saudi Arabia.

METHODOLOGY

A cross-sectional design was employed. A random sampling method was used to select 2,295 individuals from the Saudi community. Participants completed an electronic closed-ended, pre-validated, anonymous, and self-administered questionnaire.

RESULTS

The majority of the respondents were females (71.6%) and Saudis (94.5%) aged 18 to 30 years (46.6%). The majority of the respondents correctly stated that eye injuries could cause complications (89.6%) and that common substances that could result in eye injuries are chloride and detergents (93.3%) and battery materials (73.1%). Furthermore, complications after eye injuries could include blindness (80.6%), perforation (44.5%), and scar formation (38.1%). A substantial proportion of the respondents indicated that water should be used to treat chemical injuries due to acidic and alkaline substances (68.1%). However, only a small proportion of the respondents correctly answered that the eyes should be washed for 30 minutes or more after an ocular injury (7.9%).

CONCLUSIONS

The overall knowledge levels on injury mechanisms and complications were generally high with a lack of knowledge regarding immediate management for injuries. Therefore, there is a need for targeted educational interventions and training programs to enhance the general public's understanding of immediate management strategies for chemical eye injuries.

Ocular-periocular burns in a tertiary hospital: Epidemiologic characteristics

PURPOSE

Ocular burns are ophthalmic emergencies that can cause devastating injuries. This study aimed to analyze the epidemiology, complications, and management of ocular-periocular burns.

METHODS

A total of 193 patients with ocular-periocular burns were admitted to our tertiary hospital from January 2018 to December 2020. The demographic characteristics of the patients, injury variables, complications, and treatments were evaluated.

RESULTS

There were 142 male (73.6%) and 51 female (26.4%) patients with a mean age of 32.53±17.75 years. The average total body surface area was 12% (range, 1-80%). Injuries were most common at work (52.3%) and home (36.3%). Thermal burns were the most common injuries (74.6%), followed by chemical (14.5%) and electrical burns (10.9%). Alkaline agents (75.0%), mainly sodium hydroxide and lime, were common in chemical burns. Superficial lid burns were significantly higher in the thermal group (p < 0.001), and grade III-IV corneal burns were significantly higher in the chemical group (p < 0.001). Various complications were developed in 50 (13%) eyes. Medical treatment only was performed in 318 (82.4%) eyes, and additional surgical treatment was performed in 64 (17.6%) eyes; however, 54 (14.0%) underwent more than one surgery. The most common complications were corneal scars (7.3%), limbal deficiency (4.1%), and ectropion (3.9%). The most frequent procedures performed were amniotic membrane transplantation (AMT) (11.9%) and tarsorrhaphy (6.7%).

CONCLUSION

Chemical burns, limbal and conjunctival ischemia, and full-thickness eyelid defects had a poor prognosis. The degree of limbal deficiency and ınjury of intraocular structures were found to have a great influence on the outcome of their visual acuity.

Community-level awareness of proper immediate steps regarding ocular chemical injury in the Jazan region, Saudi Arabia

Background

Although the eyes represent 0.1% of the total human body, they are exposed to many injuries, some of which may cause blindness. Ocular chemical injury is a true ocular emergency requiring immediate assessment and initiation of treatment. The present study targeted the general population in the Jazan region, Saudi Arabia, to evaluate knowledge of chemical injuries to the eye and the immediate management of the injury.

Materials and methods

A cross-sectional design was employed using a convenience sample of 536 residents of the Jazan region who completed an online, self-administered, anonymous, and pre-validated questionnaire.

Results

Most of the respondents were 18-30 years of age (66.0%), and 274 (51.1%) were female. Respondents had an average score of 7.70 (standard deviation: 1.78) out of a total score of 16, indicating an overall lack of knowledge of ocular chemical burns. The majority (95.1%) agreed that ocular complications could result from ocular chemical injury. Regarding the first action in ocular chemical injuries, 317 (59.1%) thought that eye irrigation with a large amount of water, 155 (28.9%) chose to go to the emergency department, 40 (7.5%) chose irrigation of the eye with a small amount of water, 13 (2.4%) chose using eye drops, and 11 (2.1%) chose to cover the eye.

Conclusion

The knowledge of ocular chemical burns is lacking in the general population of the Jazan region. There are several knowledge gaps, some of which are serious, necessitating rigorous efforts to correct them through educational programs at the community level.

Population-level investigation of the knowledge of ocular chemical injuries and proper immediate action

Objective

Although the eyes occupy 0.1% of the total body surface, eye injuries are serious because vision is arguably the most important sense. We aimed to assess knowledge of Saudi Arabian residents regarding steps to be taken in cases of chemical eye injury, in order to promote awareness of such procedures.

Results

A cross-sectional design was done. A random sampling method was utilized to select 888 individuals in the Saudi community. Participants completed an electronic closed ended, validated, anonymous, self-administered questionnaire. Two experts assessed content and face validity. Respondents were 18–29 years of age. 74 (8.3%) had a history of chemical eye injury. Regarding the first step taken in case of chemical eye injury, 697 (78.5%) respondents indicated washing with water, 164 (18.5%) indicated visiting the emergency department, 11 (1.2%) indicated using eye drops, and 5 (0.6%) indicated covering the eye immediately. Seventy-five (8.4%) respondents agreed that an eye injured with an acidic material should be washed with an alkaline solution. These results should be confirmed by health authorities and appropriate interventions should be developed for improving knowledge among masses, thereby promoting a healthier society.

Knowledge & awareness of burn first aid among health-care workers in Saudi Arabia: Are health-care workers in need for an effective educational program?

Objective:

The objective of this study was to assess the level of awareness and knowledge of first aid for burns among healthcare workers in Saudi Arabia.

Methods:

We conducted a cross-sectional study between September 2 and December 5, 2019, via a self-administered online questionnaire among healthcare workers at a university hospital. The questionnaire comprised 24 questions divided into two sections pertaining to demographics and first aid for burns. This study was approved by the Research Ethics Committee.

Results:

We included 1,438 respondents in this study. Females comprised 68.2% (982) of the respondents. A total of 513 respondents (35.7%) were medical students. The mean burn knowledge score of all respondents was 8.07 ± 2.03 out of 13. Interestingly, 940 individuals (65.4%) used traditional medications on the burn area. Knowledge regarding antibiotic use in burn injuries was poor—1,199 (82.3%) study participants agreed that antibiotics are beneficial in the case of burns, which is a wrong act. The mean knowledge score was significantly different across groups of different ages, sexes, nationalities, marital statuses, and job positions (P < 0.001).

Conclusion:

The level of awareness of first aid for burn patients among healthcare workers was insufficient, and the unnecessary use of traditional medicines and antibiotics in burn patients being high. Moreover, this study confirmed the need for an effective educational program among healthcare workers.

Chemical mismanagement and skin burns among hospitalized and outpatient department patients

Purpose. This article attempts to elucidate the nature of chemicals causing major and minor skin burns, and their associated characterization across different industries, using Fujian provincial hospitals' admission and outpatient department records. Materials and methods. Data were collected from the provincial hospitals of Fujian through a questionnaire, sent via email, from June 1, 2017 to November 30, 2017. The collected responses were statistically analyzed using SPSS version 19 through the interquartile range, median, Mann-Whitney U test and Fisher's exact test with two-tailed significance. Results and conclusions. The results of 306 collected responses reveal that the majority of skin burn cases are due to a lack of technical education and professional training among workers handling chemicals. This study suggests that management's effective supervision and governmental regulations may help to prevent chemical skin burns at work, and can further be controlled by hiring professional workers alongside providing training to them in chemical handling as well as using protective equipment and developing appropriate management policies to improve victims' well-being and quality of life. Findings will help workers, doctors, hospitals, industries, government and other stakeholders to understand and control chemical hazards on site to minimize the risks of chemical skin burn incidents.

Epidemiologic Investigation of Chemical Burns in Southwestern China from 2005 to 2016

The epidemiological characteristics of chemical burns vary in different regions of the world. This study aims to survey the epidemiology, outcomes, and costs of chemical burns in southwest China, to determine associated risk factors and to obtain data for developing an effective approach to prevent and treat chemical burns. This retrospective study includes 410 cases with chemical burns admitted to the Institute of Burn Research of Southwest Hospital from 2005 to 2016. Data, including demographic, etiology, outcomes, and costs, were collected and analyzed. A total of 410 cases admitted to our burn center were included. The average age of the burn patients was 38.58 ± 14.66 years. The incidence of chemical burns peaked in autumn. The most common etiology were acids. Limbs were the most common burn sites (59.51%). Average total body surface area (TBSA) was 12.37 ± 18.67%. The percentage of patients who underwent procedures and the number of procedures were significantly greater for TBSA and full-thickness burns. The mortality of chemical burns was 1.22%. The median length of stay (LOS) and cost were 21 days and 65,852 CNY, respectively. The major risk factors for cost were the number of procedures, TBSA and full-thickness burns, the major risk factors for LOS were the number of procedures and outcome. Chemical burns mainly occurred in adult males with occupational exposures to chemical agents due to inappropriate operation. Emphasis on safety education for the public and professional pre-employment training for workers should become key preventive targets to reduce the incidence of chemical burns.

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

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.

Osseointegrated Implants: An Alternative Approach in Patients with Bilateral Auricular Defects due to Chemical Assault

Acid attacks committed as crimes of passion are unfortunately becoming far from infrequent occurrence. The injuries sustained in such attacks mainly involve the face and trunk, with the acid causing cutaneous and subcutaneous tissue burns that can result in permanent scarring, loss of the nose or external ear, and severe visual impairment. Different surgical solutions have been proposed for reconstruction of the auricle following loss of the ear through traumatic injury or cancer or in patients with congenital defects: surgical reconstruction may involve the insertion of an autogenous rib cartilage framework or the use of a porous polymer material inserted into an expanded postauricular flap. Reconstruction with rib cartilage has given good results but requires more than one surgical step and may be associated with adverse events involving both the donor site and the recipient site, while rejections of polymeric prostheses have been reported following their insertion into expanded postauricular flaps. The use of a titanium dowel-retained silicone prosthesis, in which the dowel is anchored to the temporal bone, is a surgical possibility, indicated particularly in cases of pinna resection due to tumour or auricular scarring following traumatic injury.

Analysis of medical expenditure and socio-economic status in patients with ocular chemical burns in East China: a retrospective study

Background

Little has been known regarding the relationship between ocular chemical injury and victims’ medical expenditure, income loss and socio-economic status changes. So we conduct this retrospective cross-sectional study in patients with ocular chemical burns in East China.

Methods

Fifty-six patients were enrolled and required to complete a self-report questionnaire consisting of the following contents: entire expenditure on medical treatment; the victims’ personal and household per capita income, and income loss caused by the injury; and the changes of socioeconomic status as well.

Results

The median expense of medical treatment was CNY 40,000 (approximately US$5,900). The medical expenditure rose significantly with increased injury severity, prolonged hospital stay, and increased frequency of surgery. More than half victims (51.8 %, 29/56) paid all or the majority of medical expense by themselves. The expense of only 5 victims was mainly paid by medical insurance, accounting for less than ten percent (8.9 %, 5/56). The victims’ personal and household per capita income both decreased significantly after the injury, with the median reduction being CNY 24,000 and CNY 7,800 (approximately US$3600 and US$1200) per year respectively. The reduction amplitude of personal and household per capita income rose with increased injury severity and prolonged time of care required. The injury caused emotional depression or anxiety in 76.8 % (43/56) victims, and the relationship with their relatives got worse in 51.9 % (29/56) patients. Moreover, only 21.4 % (12/56) patients felt that the whole society gave them care and concern after the injury, whereas 46.4 % (26/56) and 28.6 % (16/56) felt indifference or discrimination from society as a whole (X² = 16.916, P = 0.028).

Conclusions

The medical expense was a huge economic burden to most victims of ocular chemical burns, and personal and household per capita income of the victims decreased significantly after injury, both of which had a close relationship with the injury severity. Formal legislation was urgently needed to compel the employer to purchase injury or medical insurance and provide more compulsory protection to the population working in high risk occupations. In addition, psychological counseling and instruction shouldn’t be neglected in the aid and treatment of victims.

Occupational chemical burns: a 2-year experience in the emergency department

Chemical burn injuries are a result of exposure to acid, alkali, or organic compounds. In this retrospective study, a total of 21 patients suffering occupational chemical burns, came to the emergency room at the University General Hospital of Alexandroupolis, from 2008 to 2010; 76.2% were workers, 19% were farmers, and 4.8% were desk officers. The majority of burns were due to exposure to acid (61.9%). Upper extremities were the most frequently injured area followed by the lower extremities and thorax. None of the patients needed further hospital care, but in the follow-up, four of the patients suffered keloid. Proper surgical treatment at the emergency room decreases the length of hospital stay for patients who suffer chemically induced burns.

Epidemiology of burn injuries in the East Mediterranean Region: a systematic review

BACKGROUND

Burn injuries remain one of the leading causes of injury morbidity and mortality in the World Health Organization's East Mediterranean Region. To provide an overview on the epidemiology of burn injuries in this region, a systematic review was undertaken.

METHODS

Medline, Embase and CINAHL were searched for publications on burns in this region published between 01/01/1997 and 16/4/2007. Data were extracted to a standard spreadsheet and synthesised using a narrative synthesis. No attempt has been made to quantitatively synthesise the data due to the large degree of clinical heterogeneity between study populations.

RESULTS

Seventy one studies were included in the review, from 12 countries. Burn injuries were found to be one of the leading causes of injury morbidity and mortality. The reported incidence of burns ranged from 112 to 518 per 100,000 per year. Burn victims were more frequently young and approximately one third of the victims were children aged 0-5 years. Hospital mortality ranged from 5 to 37%, but was commonly above 20%. Intentional self-harm burns particularly involving women were common in some countries of the region and were associated with a very high mortality of up to 79%.

CONCLUSION

Burn injuries remain an important public health issue in the East Mediterranean Region therefore further research is required to investigate the problem and assess the effectiveness of intervention programmes.

Chemical assault and skin/eye burns: two representative cases, report from the Acid Survivors Foundation, and literature review

Chemical assault is a significant problem throughout the world, resulting in disfigurement, sometime blindness or vision impairment, and constituting a major economic burden on otherwise overwhelmed health services in developing countries. Two representative cases are presented here. One involved domestic spouse abuse with an acid and the second involved a teen-aged female assaulted with an acid, perhaps for retribution over a local judicial matter. Such atrocities have a world-wide scope, which is reviewed here. Preventive measures are the most appropriate response. However, when such chemical assaults do occur, active measures to mitigate or negate their effects deserve consideration.

Epidemiology and outcome of 121 cases of chemical burn in East Azarbaijan province, Iran

AIM

To explore the epidemiology, mechanisms, complications, morbidity and mortality associated with chemical burns.

METHODS

Data from 121 cases of chemical burn treated in our department over a 5-year period were compared. Data were obtained by prospective proforma.

RESULTS

A mean 7.98% of total body surface area was burned. This series had a male:female ratio of 10:1, with a mean age 35.3 years. Young men experiencing work-related accidents were the most frequent victims. The majority of chemical burns occurred away from home (98.3%), particularly in the working environment (78.5%); 111 (91.7%) burns were accidental and 10 (8.3%) constituted criminal assault. Tar was the most frequent agent involved, followed by acid, and the hands were the most frequent site of injury. Most burns were small and of second degree; 10.7% of cases involved serious ocular damage. The mean hospital stay was 10 days, and the mortality rate was 1.7%.

CONCLUSIONS

Constant safety education for the public and professional training for workers would reduce the incidence of chemical burns. Prevention strategies must be coordinated on a national level.

Cases of chemical assault worldwide: A literature review

We reviewed 24 studies of chemical burns by means of assault in the last 40 years. We describe 771 cases of chemical assault in total. Jamaica had the largest absolute number of cases. Bangladesh had the highest reported incidence. Male victims were more common, with the exception of Bangladesh and Taiwan. The youngest cohort was from Bangladesh. The role of gender, agents used and legislation were discussed. We identified two broad motives; increases in violent crime and use as a crime of passion in disputes between men and women.

Corrosive injury from arterial injection of hydrochloric acid

This report presents a case of hydrochloric acid injection in the inguinal area in a suicide attempt, resulting in total occlusion of the external iliac artery, requiring disarticulation of the hip. To the authors' best knowledge, it has not been previously reported in the English medical literature. The accelerated destructive activity of these irritant chemicals and deep tissue damages are emphasized. Early and aggressive debridement with copious saline irrigation and circumspect monitoring are recommended.

Epidemiology of 377 patients with chemical burns in Guangdong province

A total of 377 patients with chemical burns from all over Guangdong province were admitted to the Guangzhou Red Cross Hospital during the period from January 1987 to December 2001. There were 296 males and 81 females with a male to female ratio of 3.65:1. The mean age of the patients was 26 years. The majority of patients (89.2%) were in the age range of 15-60 years. Professionally, 244 patients (64.7%) were workers, of whom, 232 (95%) of patients were peasant workers. Most of the chemical burns occurred at places away from home (94.4%), especially in the working environment (67.8%). Only 20 patients (5.5%) were injured at home. Chemical burns by accident and by criminal assault were 337 (88.5%) and 40 (10.5%). Strong acids (60.8%), mainly sulfuric acid, nitric acid, hydrofluoric acid, alkali (33.9%), mainly lime and sodium hydroxide were common causative agents. There was a relationship between the incidence of chemical burns and the season, with more patients in July-September and October-December. There were 215 (57.1%) patients who washed the burnsite with water immediately, but the volumes of water and time of washing were not adequate. Patients with total burn surface area (TBSA) of less than 10% comprised the majority of patients (72.7%), with 188 (65.7%) deep partial thickness burns, 116 (40.6%) with full thickness burns, and 60 (21%) with superficial burns. Extremities (lower limb 56.6% and upper limb 51.4%) were the most frequent area of injury. Ocular burns were the most common accompanying injury (14.7%). Operations of autografts and conjunctival flap were carried out on 159 (42.2%) patients. The average period of hospitalization was 22 days. Only 2 (0.7%) deaths occurred in this study. Counter measures to improve this situation must include safety productive education and professional training, use of protective clothing at work, enhancing the concept of legal responsibility, and restricting management and use of corrosive chemicals. Irrigation of the burnsite promptly with substantial volumes of water and an adequately long time will help reduce the morbidity from chemical burns.

Chemical assaults in Hong Kong: a 10-year review

The aim of this study was to assess the patients admitted to Prince of Wales Hospital Burns Unit, Hong Kong between September 1991 and August 2001 following chemical assault. A total of 2319 burns were admitted during the study period of which 19 had been subjected to chemical assault. All victims sustained a burn injury to the head and neck area and 47% of victims' eyes were burnt. A total of 84% required surgical intervention. Where a reason for the attack was admitted most were due to relationship difficulties. This study has defined the victims of chemical assault in Hong Kong. At a time when the overall number of assaults in Hong Kong is at its lowest level for 5 years it is of concern that there appears to have been a recent increase in the number of chemical assaults in Hong Kong.

Delayed primary excision and grafting of full thickness alkali burns of the hand and forearm

In a prospective study, 15 cases of domestic alkali drain cleaner burns involving the dorsal aspect of the hand and forearm were included. There were ten males and five females. The average age was 27 years and the mean total body surface area burnt was 2%. All patients failed to do immediate water lavage at home and hence all wounds ultimately required excision and grafting. Patients were initially treated with daily silver sulfadiazine dressing on an out-patient basis. Seven to 9 days after injury, patients were admitted to hospital and underwent excision and grafting. On final follow-up, there was excellent return of function, which was assessed using the grip strength of the hand and the range of motion of the wrist and fingers. Cosmetic appearance and texture of the graft were assessed according to a proposed grading system. The cosmetic result was considered satisfactory in 12 patients and poor in three patients. There were no excellent cosmetic results, because of hyperpigmentation of the healed graft. Advantages of delayed primary excision and grafting of full thickness alkali burns of the hand and forearm are discussed.