Written By: Dr. Jassin Jouria
A 39-year-old male construction worker presents to the Emergency Room after accidentally injuring himself with a nail gun at work. He was inadvertently bumped by another worker in close proximity and punctured his hand with a nail gun. He is brought to the Emergency Department with the nail still stuck in his hand. He is complaining of localized pain but has not seen any bleeding. The Emergency Room physician immediately orders X-rays and a tetanus shot while assessing the wound and vital signs.
Penetrating injuries can be classified as injuries caused by an object piercing the skin. This ends up damaging the tissues and results in an open wound. An employee suffering from a penetrating injury might go through severe pain and lose a lot of blood. Penetrating injuries are one of the worst injuries because they pose several threats.
Statistics on Nail Gun Penetrating Injuries
According to research, 75% of nail gun injuries involve soft tissues while 25% involve structural damage. Also, 65% of nail gun penetrating injuries occur in the hand. Other common sites include the neck, head, spinal cord, abdomen, and vertebral column.
Another Australian study in Victoria for nail gun injuries showed in 5 years:
- 98.5% were male
- 67% involved injuries to the hand
- The admission rate was 23%
What Kind of Machinery Leads to Penetrating Injuries?
Workers who deal with machines with sharp heads are prone to have penetrating injuries. Below are some of the machines that can lead to penetrating injuries:
- Drills and drilling equipment
- Workers dealing with knives
- Nailing guns and nailing equipment
- Workers dealing with injections and needles
- Healthcare workers dealing with surgical instruments
Preventing Penetrating Injuries
Employees in workplaces with high chances of suffering from a penetrating injury should have a risk management plan in place to eliminate or minimize the risk of penetrating injuries caused by sharp objects like nail guns.
Follow the steps below:
Step 1: Identify the presence of sharp hazards at your workplace
- The employer must conduct a walk-through survey to identify activities, tasks, and locations where hazards might exist.
- Conduct workplace safety and health audits
- Analyze data and records – this means looking back into past penetrating injuries that have occurred in the workplace to be able to predict future penetrating injuries and prevent them from happening.
- Consult other organizations and request information about penetrating injury accidents and how they were able to manage them.
- Consult with workers, safety and health committees, and representatives.
Step 2: Assess the risk
- Likelihood of occurrence, e.g., how often are sharp objects like nail guns and other sharp objects found at the workplace
- What is the total volume of sharp objects at the workplace, e.g., the number of discarded sharp objects found at work?
- The total number of employees who handle sharp objects
- Total number of employees who do not wear protective hand gloves when handling or working with sharp objects like nail guns
- Experience and skills of workers who handle sharp objects, e.g., have workers received adequate training on nail gun safe work practices to prevent penetrating injuries?
- The effectiveness and availability of control measures at the workplace, e.g., do employees work with suitable equipment such as hand gloves and protective glasses for safe handling of sharp objects?
Step 3: The employer must lay out control measures:
- Prevent the risk or get rid of the harm by:
- Using nail guns with protective gears
- Avoid work that involves using sharp objects
- If you can’t get rid of the harm (situations when you have to do the job):
- Consider using safety-engineered nail guns
- Change the physical environment or the work processes
- Implement administrative arrangements for example:
- Introduce safe work practices which could include workers not:
- Placing their fingers or hands close to nailing a gun sharp nail
- Passing sharp objects between coworkers
- Holding the base of nail guns
- Introduce safe work practices which could include workers not:
- Arrange for safe disposal of sharp objects
- Keep records of training, information, and supervision regarding:
- Safe work practices
- Managing penetrating injuries
- Infection risk
- Safe disposal and handling of sharp objects
- Introduce surveillance to ensure prompt disposal and detection of discarded sharp objects
- Introduce a system that manages penetrating injuries which include:
- Prompt medical referral
- Instructions for first aid
- Counseling
- Ensure that workers who frequently use sharp objects are immunized against hepatitis B. Also, keep immunization records.
Step 4: Review control measures to ensure the employees:
- Are working properly
- Are sustainable and being maintained
- Have been implemented correctly
- Are not bringing new problems
Tips on Managing Penetrating Injuries
It can be traumatizing to experience a penetrating injury yourself or see someone else experience it. It is easier said than done but try to stay calm.
The first thing to do is get yourself and anyone else involved to a safe location. If the injury was due to an instrument, turn it off once it is safe. Once you are safe, you can try the below measures to control the damage due to penetrating injury.
- Hemorrhage Control: The first thing one needs to do after having a penetrating injury is to control the bleeding and assess the injury. As long as the patient has a heartbeat, you only need to focus on bleeding control. It is also encouraged for all injury personnel at the workplace to take The Stop the Bleed course.
- Blood Transfusion: Along with hemorrhage control, a person who experienced penetrating injury with signs of hemorrhagic shock needs an immediate blood transfusion. It is also important to have a universal donor, or o-negative blood at all times.
- Imaging: A worker suffering from penetrating injury should get imaging to look for injury to tissues and bones. The follow-up therapy will depend on the extent of the damage. It can range from simple bandages to surgery.
If you are unfortunate to experience penetrating injury, you should seek proper medical attention and advice. Immediately visit the nearest healthcare center to speak with a doctor. Always try to avoid working around sharp objects.
Make sure you let the occupational therapist at your workplace know about the incident.
Meet the Author Dr. Jassin Jouria
Dr. Jassin Jouria is a practicing Emergency Medicine Physician who specializes in resuscitation of critical patients. The majority of his clinical work is at the Decatur County Memorial Hospital Emergency Department in Greensburg, Indiana. Learn More About the Author.
References:
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- https://www.worksafe.qld.gov.au/safety-and-prevention/hazards/hazardous-exposures/biological-hazards/skin-penetrating-injuries
- https://www.mayoclinic.org/medical-professionals/trauma/news/managing-penetrating-trauma/mac-20518677
- https://www.hse.gov.uk/healthservices/needlesticks/
- https://pubmed.ncbi.nlm.nih.gov/1596233/
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