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Case Report
Ethylene oxide burn in a chemical plant worker: a case report
Youngwook Kim, Sangchul Roh
Ann Occup Environ Med 2021;33:e23.   Published online July 1, 2021
DOI: https://doi.org/10.35371/aoem.2021.33.e23
AbstractAbstract AbstractAbstract in Korean PDFPubReaderePub
Background

Ethylene oxide is a chemical agent that is widely used for the sterilization of medical equipment and the manufacture of chemicals. Although ethylene oxide burns are frequent and can be severe, many workers are unaware of their risks.

Case presentation

A 45-year-old man presented with painful exudative lesions on the right foot after working with ethylene oxide solution in a chemical plant. The patient stated that the solution had percolated through his shoe and he had not washed the solution off for 5 hours. Symptoms, including pain and erythema, appeared after a delay of more than 12 hours from the time of initial exposure. The skin of his right foot was irrigated with saline and covered with a wet dressing and topical antibiotics in the emergency department. The patient was followed up for 4 weeks at an outpatient clinic.

Conclusions

Ethylene oxide causes skin irritation, dermatitis, and burns in severe cases. Since skin reactions can be delayed for more than 12 hours after exposure, it is important to remove contaminated shoes and clothing immediately and wash the exposed area even in the absence of symptoms. It is also necessary to provide the appropriate protective equipment and educate workers on the dangers of ethylene oxide.

화학플랜트에서 발생한 산화에틸렌에 의한 화학화상 1예
서론: 산화에틸렌은 의료기기 살균 및 화학제품 제조에 널리 사용되는 물질이다. 산화에틸렌에 의한 화상은 빈번히 발생하며 심각한 합병증을 가져올 수 있지만 많은 근로자들은 그 위험을 인지하지 못하고 있다.
증례
45세 남성이 화학 공장에서 산화 에틸렌 용액으로 작업 한 후 오른발에 통증을 동반한 삼출성 병변을 보였다. 산화에틸렌용액이 근로자의 신발에 스며 들었고 5 시간 동안 용액을 씻어 내지 않았다. 통증 및 홍반을 포함한 증상은 초기 노출 시점으로부터 12 시간 이상 지연된 후 나타났다. 응급실 내원하여 병변 부위 식염수 세척 및 드레싱, 국소 항생제로 치료를 받았다. 그 후 4 주 동안 외래진료 및 추적 관찰 받았다.
고찰
산화 에틸렌은 피부 자극, 피부염을 유발하며 심한 경우 화상을 일으킨다. 피부 반응은 노출 후 12 시간 이상 지연 될 수 있으므로 노출 즉시 오염된 신발과 의복을 벗고, 증상이 없는 경우에도 노출 부위를 씻어내는 것이 중요하다. 또한 적절한 보호 장비를 제공하고 작업자에게 산화에틸렌의 위험에 대해 교육 해야 한다.
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Original Article
Sister Chromatid Exchanges in Workers Occupationally Exposed to Ethylene Oxide
Soung Hoon Chang, Won Jin Lee, Cheong Sik Kim, Cheong Hyun Hwang, Jong Tae Park, Dae Seong Kim, Young Whan Kim
Korean Journal of Occupational and Environmental Medicine 1998;10(4):428-437.   Published online December 31, 1998
DOI: https://doi.org/10.35371/kjoem.1998.10.4.428
AbstractAbstract PDF
Operators of hospital sterilizers who use ethylene oxide (EtO) were studied to determine the exposure of EtO level and the frequency of sister chromatid exchanges (SCEs) from June 12 to July 20, 1997. To evaluate SCEs in the peripheral blood cells, we selected 22 workers at the central supply room of 4 university hospitals and 22 unexposed workers at the same hospitals according to match sex, age, and smoking habit and also did questionnaires. The mean air concentrations (8-hr TWA) of EtO at 4 university hospitals were less than 1 ppm. The SCE frequencies in exposed workers to EtO and controls were normally distributed. The SCE frequencies in exposed workers to EtO and controls were 6.42+/-.63, 5.86+/-.69, respectively and their differences were statistically significant (p=0.0093). But there were no statistically significant differences in smoking, alcohol intake, coffee drinking. Especially smokers who exposed to EtO were increased SCE statistically significant than the exposed group who did not smoke.

Citations

Citations to this article as recorded by  
  • Analysis of Micronuclei and Its Association with Genetic Polymorphisms in Hospital Workers Exposed to Ethylene Oxide
    Sun-Yeong Lee, Yang-Jee Kim, Young-Joo Choi, Joong-Won Lee, Young-Hyun Lee, Mi-Yeon Shin, Won Kim, Chung-Sik Yoon, Sung-Kyoon Kim, Hai-Won Chung
    Korean Journal of Environmental Health Sciences.2011; 37(6): 429.     CrossRef
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Original Article
Neurobehavioral Tests in Workers Exposed to Ethylene Oxide
Kang Won Park, Young Gi Kim, Ju Hyun Byun, Jin Ha Kim, Young Hawn Lee, Kang Ryune Kim
Korean Journal of Occupational and Environmental Medicine 1998;10(3):301-309.   Published online August 31, 1998
DOI: https://doi.org/10.35371/kjoem.1998.10.3.301
AbstractAbstract PDF
Ethylene oxide is widely used to sterilize heat-sensitive materials in hospital. Previous reports for neurotoxic effects of ethylene oxide have been described in animals and humans. To assess the exposure level and neurobehavioral effect of ethylene oxide, a cross-sectional study was performed to 27 nurses from central supply unit at hospital, exposed to ethylene oxide and 32 nurses as reference. Ethylene oxide was collected with using a personal air sampler and analyzed by gas chromatography for the determination of exposure level, and five items among Neurobehavioral Core Test Battery (NCTB) of World Health Organization, including Digit Span, Benton visual retention. Santa Ana dexterity, Digit Symbol and Simple reaction time, were administered to the exposed and reference group. The mean exposure level was 0.63 ppm in the exposed group and six subjects were exposed above the level of 1 ppm, which is currently regulated by the Korean Ministry of Labor. The results of neurobehavioral test in the exposed group showed significantly poorer performances in Digit Span forward and backward, Benton visual retention and Simple reaction time, comparing with the reference group. When the exposure level was divided into below and above the level of 1 ppm, there were significant differences in performance on Benton visual retentions, Digit Symbol and Simple reaction time. Also, Digit Span forward and backward showed significantly poorer performances below the level of 1 ppm, compared with reference group. Simple reaction time was still significantly delayed by the exposure level after controlling the confounding factors with multiple regression analysis. The results suggest that the periodic measurement of ethylene oxide in hospital and health care program is needed.

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