EH&S News

Environmental Health and Safety

University of Massachusetts at Amherst

Editor: Robert DiCarlo Winter 1999 Vol. 5 No. 4

Inside This Issue

Lab Safety

Severe Lung Injury

Holiday Fire Safety

Pedestrian Safety

LAB SAFETY

Researchers are reminded to use caution when picking up materials from the VWR Stockroom in Room 5 of the LGRC.

Here are some reminders:

1. When you are scooping dry ice out of the freezer chest be sure to keep your head out of the compartment so you will be able to avoid breathing in the carbon dioxide vapors. The MSDS indicates that carbon dioxide vapors are heavier than air and create an oxygen deficiency.
2. Use secondary containment when transporting hazardous substances to your lab. Containers are available in the stockroom.
3. Wear eye and splash protection when you are filling liquid nitrogen containers.

SEVERE LUNG INJURY

The inhalation of the noxious fumes associated with the mixing of household cleaners can lead to pulmonary irritation and pneumonitis. Household ammonia (3 to 10 percent aqueous NH3) and bleach (5 percent NaOCl) are two of the most common cleaning agents. Combining them releases chloramine gas, which is a combination of monochloramines (NH2Cl) and dichloramines (NHCl2). When inhaled, chloramines react with the moisture of the respiratory tract to release ammonia (NH3), hydrochloric acid (HCl), and oxygen free radicals. Typically exposures to low concentrations of chloramines produce only mild respiratory tract irritation. In higher concentrations, the combination of hydrochloric acid, ammonia, and oxygen free radicals may cause corrosive effects and cellular injury, resulting in pneumonitis and edema.

Emergency tracheostomy was required in a patient because of upper-airway compromise induced by chloramine gas. The patient, a previously healthy 53-year-old woman, was cleaning a walk-in freezer at her workplace with over-the-counter liquid ammonia and bleach. The door to the freezer was closed, and there was no air exchange with the outside. Approximately 30 minutes after beginning to clean, she noted shortness of breath and called 911. Over the next three hours, she had increased tightness of the throat and became unable to speak above a whisper.

Despite aggressive use of nebulized albuterol, racepinephrine, and intravenous steroids, her symptoms progressively worsened. Rapid-sequence intubation was attempted but was unsuccessful because of swelling of the upper airway. Emergency tracheostomy was performed. The initial chest radiograph was unremarkable, but radiologic evidence of pneumonitis developed over the next four hours. At the time the second radiograph was obtained, the arterial-blood gas showed a pH of 7.23, partial pressure of carbon dioxide of 49 mm Hg, and partial pressure of oxygen of 102 mm Hg while the patient was breathing 100 percent oxygen with assisted ventilation. The patient received supportive care. Her tracheostomy was removed within five days, and she was discharged from the hospital within seven days.

Although it occurs infrequently, exposure to chloramine gas represents a substantial risk when household cleaners containing bleach and ammonia are mixed. As the course of our patient illustrates, upper-airway irritation can compromise the airway and require emergency tracheostomy.

References

1. Gapany-Gapanavicius M, Molho M, Tirosh M. Chloramine-induced pneumonitis from mixing household cleaning agents. BMJ 1982;285:1086.
2. Reisz GR, Gammon RS. Toxic pneumonitis from mixing household cleaners. Chest 1986;89:49-52.
3. Pascuzzi TA, Storrow AB. Mass casualties from acute inhalation of chloramine gas. Mil Med 1998;163:102-4.
4. Mrvos R, Dean BS, Krenzelok EP. Home exposures to chlorine/chloramine gas: review of 216 cases. South Med J 1993;86:654-7.

Source: The New England Journal of Medicine

September 9, 1999

Vol. 341, No. 11, Winter 99

HOLIDAY FIRE SAFETY

With the holiday season approaching here are some safety tips for decorating.

1. Never block, hide, or disguise an exit.
2. Keep exits free and clear from combustibles and obstructions.
3. Decorations or furnishings must not constrict or obstruct corridors.
4. Never place combustibles in corridors or lobbies.
5. All exits should have illuminated exit signs.
6. Fabrics and other combustibles should not be hung from ceilings.
7. Massachusetts Fire Prevention Regulations prohibit flammable decorations such as natural greens, straw, crepe paper, and streamers in school buildings, places of public assembly, corridors and stairways.
8. Any holiday lighting must have a tag that sys the lighting is approved by a certified testing lab such as UL or Factory Mutual.
9. Cut trees are not allowed to be used in public buildings. If you use an artificial tree it must be flame retardant.

If you have nay fire safety questions please call EH&S at 5-2682. Hope you have a safe Holiday season.

PEDESTRIAN SAFETY

Millions of injuries and deaths are caused each year by motor vehicle and bicycling accidents, choking, poisoning, fires and household hazards. Every age has its dangers: small objects put in the mouth may harm a toddler; sports or motor vehicle accidents can leave older children, teens and adults banged up or worse; and a loose rug or an inadequate eyeglass prescription can be a threat to people who are elderly or disabled.

Fortunately, you can do a lot to prevent accidents:

• Ask your doctor or nurse practitioner for age-appropriate publications on safety, including fire precautions, childproofing your home, and the Harvard Pilgrim Health Care pamphlet "Bicycle Safety."
• Wear safety belts and use infant and child safety seats whenever you're in a car. Always put a baby in the back seat, facing rear, until 20 pounds or age one. The front seat is especially dangerous in cars with passenger-side airbags, which can strike the back of a car seat with tremendous force when inflating.
• Do a home safety check. List what needs to be done and fix the most worrisome items first. Often, simple changes -- like turning pot handles toward the back of the stove where toddlers can't reach them -- can make a big difference.
• Bikes and roller skates may provide hours of safe fun if children understand traffic safety and wear proper equipment for the sport, such as well-fitting helmets and elbow and knee pads.
• Sign a family pact for safety. For a teenager, that might include a contract asking for parental car service after a party if the teen -- or a friend who's driving -- has been drinking. For all family members, it could include practicing fire escape routes and keeping poison control and other emergency numbers by the phone.

Harvard Pilgrim Health Care. Copyright © 1998.

Environmental Health and Safety News

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