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Sophia, a third-year undergraduate student was working alone in the laboratory and preparing a dilute ammonia solution for her final-year research project. She accidentally spilled some of the concentrated ammonia solution onto her skin and some splashed into her eye when pouring water into the ammonia solution. She was panic and started to rub her eyes due to the pain and sting caused by the chemical. The laboratory assistant quickly attended to her with first aid. Sophia’s eye was tearing, and she was sent to the nearest clinic for medical attention.

The core learning issues are on the preventive measures and management principles of chemical burns.

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1. Proper PPE before entering lab

Wear of half-face respirator

Gas and Vapour Filter 6054 offers K1 protection against ammonia and its derivatives

3M™ Bayonet Connection: Flexible system for connection to 3M half and full facepiece

Lightweight with low breathing resistance

2. Buddy system:

Encourage all students to work in pairs in projects or conduct experiments with someone else in a lab to ensure assistance when needed.

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3. Seek for advice before conducting an experiment

4. Risk assessment COSHH should be conducted before every experiment, especially for concentrated ammonia and contact lens usage

5. Presence of lab assistant at all times in a research lab (supervision) to ensure and prevent accidents.

6. Wear of contact lens:

NIOSH recommends that contact lens wear be permitted provided that the safety guidelines presented in this Current Intelligence Bulletin (CIB) are followed.

To review all chemicals used to see whether any reacts or interacts with contact lenses. If so, those uses and areas need to be noted and marked so employees and visitors will be informed and can be properly protected.

Here is a just a partial list of some chemicals that can react with contact lens or are restricted due to regulatory guidance:

1,2-dibromo-3-chloropropane (DBCP): OSHA regulation
4,4'-methylene dianiline: OSHA regulation
* Ethyl alcohol: Study of absorption by Cerulli, et al. 1985
* Ethylene oxide: OSHA regulation
* Isopropyl alcohol: Study of absorption by Cerulli, et al. 1985
* Methylene chloride: OSHA regulation

*Ammonia

Comply with OSHA regulations on contact lens and eye and face protection to prevent accidental contact and harm

7. Proper training:

Comprehensive training and quiz on laboratory safety and how to handle hazardous chemicals should be provided by the institution before the final year project to ensure all students understand and adhere to the proper conduct in a laboratory setting.

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8. Proper education and training on first-aid measures:

how to treat a chemical burn, treatment of eye or inhalation poisoning should be enforced by institutions in case of emergencies.

9. Safe handling:

Enforce the guidelines on how to safely handle hazardous chemicals (Always add ammonia to water, not the other way around, to prevent violent reactions or splashes.)

Use fume hoods or well-ventilated areas to minimize inhalation risks.

10. Availability of safety equipments:

Ensure all safety stations are functioning and easily accessible in the

laboratory. (eye wash, shower and first-aid kits)

11. Clear Labeling and Storage:

Clearly label all chemical containers and store them according to safety guidelines to prevent accidental exposure.

12.  Safety Signage:

Relevance: Post clear signage in the lab indicating the hazards associated with ammonia and the required safety precautions to reinforce awareness.

13. Education and Awareness:

Conduct regular drills on emergency response to reinforce safe practices - and ensure preparedness in case of accidents.

Promote a safety-first culture in the laboratory, encouraging open communication about hazards and the importance of following protocols.

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1. No proper PPE

2. Working alone, with no request for help when needed

3. Lack of MSDS and SDS sheet

4. Direct addition of water to concentrated ammonia

5. No proper first aid emergency usage of eye wash station

6. Rubbing eyes with her hands which can worsen injury

7. No lab assistant was present to provide a 2nd line of defense to help students when they face difficulties or panic

8. The help from the lab assistant who may have heard screaming from the laboratory, attended to Sophia as fast as she could however it may have been too late.

9. Lack of knowledge and proper conduct in a laboratory setting

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Ammonia (NH3) is a colourless, pungent gas composed of nitrogen and hydrogen. Ammonia is a colourless gas with a sharp, penetrating odour. It is highly volatile and also very corrosive especially in its concentrated form. Its corrosive nature can affect various materials and living tissues, including skin, eyes, respiratory tracts and certain metal.

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It can cause blindness when you touch your eyes after handling ammonia as it is very corrosive and irritating in nature.

Ammonia is highly alkaline - so even small amounts of substance can cause significant damage to the sensitive tissues especially in the eyes as it is very fragile.

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The severity of the consequences depends on the duration of the contact of ammonia towards the body part. As the case majorly informed about her touching her eyes, not mentioning the duration of time, we can conclude that

Can cause eye irritation

As a brief contact of ammonia towards the eyes can cause immediate and intense irritation. Symptoms can include redness, burning, tearing and pain in the eyes.

Conjunctivitis

Can lead to inflammation of the conjunctiva. Also categorized by redness, swelling, and watery discharge.

Corneal damage

Cause chemical burns on the cornea, the clear front surface of the eye. This can lead to blurred vision, extreme discomfort and sensitivity to light. In severe cases, corneal ulcers (open sores) may form, which can significantly affect vision if not treated promptly.

Temporary or permanent vision loss

Prolonged or high concentration of ammonia contact can lead to temporary vision impairment or in severe cases, permanent vision loss. The damage could affect not only the cornea but also deeper structures within the eye, causing more profound and lasting vision issues.

This could lead to an increased risk of infection because the eye tissue is damaged and more vulnerable to fungal and bacterial infection.

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Ammonia is highly volatile and readily evaporates into the air at room temperature, especially when in its pure, anhydrous form.

Ammonia odour threshold is sufficiently low to acutely provide adequate warning of its presence. (Odour threshold = 5 ppm; OSHA PEL = 50 ppm)

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Ammonia has a boiling point of -33.34C so in a normal room temperature, it will exist as a gas.

It have a rapid evaporation as the liquid form will turn into gas, contributes to the pungent smell and disperse quickly in the air.

Can pose risk in confined and poorly ventilated spaces.

It will irritate or damage the respiratory system, eyes, and skin when inhaled or contacted. Exposure to high levels of ammonia can lead to severe health effects.

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Asphyxiation might occur when being exposed to the ammonia in the air.

Inhalation of ammonia may cause nasopharyngeal and tracheal burns, bronchiolar and alveolar edema, and airway destruction resulting in respiratory distress and failure.

However, ammonia causes olfactory fatigue or adaptation so it is quite hard to detect when exposure is prolonged.

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Children exposed to ammonia the same level as adult have to receive larger dose because they have a larger surface area:body weight ratio and increased minuted volumes:weight ratios.

They may be exposed to higher levels than adults in the same location because of their short stature and the high levels of ammonia vapour found nearer to the ground.

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Ingestion of ammonia can result in corrosive damage to the mouth, throat, and stomach. Ingestion of ammonia does not normally result in systemic poisoining.

Prolonged skin contact (more than a few minutes of ammonia) can cause pain and corrosive injury and also skin burns.

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According to OSHA section 1910.1450(h)(1)(i), employers must ensure that all hazardous chemicals are labelled according to the SDS sheet and that the labels are not removed or defaced.

Inform users of the potential hazards that may arise, preventing confusion over other chemicals and facilitate emergency responses like how to clean up spills as well as the proper medical treatment if there are accidents

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A standardized document containing important occupational safety and health information and mandated by the International Hazar Communication Standard

Covers details of specific chemicals of its chemical properties, potential health and environmental risks, recommended protective measures, and safety precautions for proper storage, handling and transportation of chemicals

Important reduce accidents while handling hazardous substances.

Chemicals may degrade into harmful substances and released into soils, waterways, and more.

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1. Spill kit [6]

Use the Hazmat spill kit to absorb the spilled ammonia

Suitable for hazardous substances like acid, corrosive chemicals, solvents, and base

Be sure to seal the used spill kit with a proper label before disposing of it through the relevant waste management

2. Neutralizing agent

Safer to remove and dispose

Easiest way is to use weak acid / base to form water and salt.

Can use citric acid or sodium sesquicarbonate if small spillage

If large spillage, may use stronger acid like diluted HCl

3. Fire extinguisher [7]

In case there is fire (ammonia gas in contact with water), ensure that the fire extinguisher available in the lab is working well

Locate the fire extinguisher

Check the tamper seal and pull pin

Both should be intact with no damage to the seal

Examine the physical condition

Look for signs of wear, tear, damage like dents, corrosions or more on the extinguisher body. Check the hose and nozzle as well for any blockages, cracks or damage

Check the pressure gauge

Needle in the green area, if in the red zone indicates the need to be replaced or serviced as it is overcharged or undercharged

Check inspection tag or label

Ensure it reflects the latest professional inspection required by OSHA standards

Record the fire extinguisher inspection

It is essential to keep track of the inspection history of each fire extinguisher so it’s easier to identify recurring issues

Communicate if there are any issues

Immediately contact relevant department or individual if there is any issues during the safety check

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1. Immediate Physical Consequences

Skin Burns and Irritation: Ammonia, a strong alkali, can cause painful burns on the skin, leading to redness, irritation, or blistering if not washed off immediately.

Eye Injury: Ammonia is highly hazardous to the eyes. Contact can cause severe pain, tearing, blurry vision, and potentially damage the cornea.

Increased Risk Due to Rubbing: Rubbing the eyes intensified contact between ammonia and the eye tissues, worsening damage to the cornea and increasing pain and irritation.

2. Short-Term Medical Complications

Corneal Burns: Exposure to ammonia may result in corneal burns, causing temporary blurry vision and sensitivity to light.

Infection Risk: Burns on the skin or eyes increase the risk of infections, which could complicate and delay the healing process.

3. Long-Term Consequences

Scarring and Vision Issues: Severe burns can leave permanent scars on the skin, while eye exposure might result in lasting vision problems or even partial blindness if the damage is extensive.

Chronic Eye Problems: Sophia may experience ongoing eye issues, such as dryness, continuous irritation, or sensitivity to light.

Psychological Impact: This incident may cause Sophia to feel anxious about working with chemicals, affecting her confidence and effectiveness in future lab work.

4. Misconduct and Its Implications

Negligence and Harm: Lab safety guidelines are designed to prevent accidents. Failing to use personal protective equipment (PPE) and not following proper handling procedures show negligence. This not only puts Sophia at risk but also highlights a lack of preparation for handling hazardous chemicals.

Incompetency in Lab Protocols: Rubbing the eyes after chemical exposure and neglecting to rinse immediately indicate a lack of basic safety knowledge, raising concerns about her readiness to work in a lab environment.

5. Penalties and Disciplinary Actions

Fines and Financial Responsibility: Sophia could be held financially responsible for medical costs if the incident is determined to be due to misconduct or failure to follow safety guidelines.

Academic Disciplinary Actions: The institution might require mandatory retraining in lab safety, impose temporary suspension from lab activities, or, in severe cases, place her on academic probation.

Institutional and Legal Liability: In some cases, significant safety breaches could lead to legal consequences, especially if serious harm results from negligence.

6. Institutional Impact and Safety Measures

Safety Review: This incident may lead the lab to review and improve safety protocols, such as reinforcing PPE requirements and potentially instituting a buddy system for chemical handling to ensure no one works alone.

Documentation and Reporting: A formal incident report is likely required for institutional records and may inform future safety training for students and staff. This documentation is critical in academic settings to minimize similar incidents.

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There are four biosafety levels. Each level has specific controls for containment of microbes and biological agents. The primary risks that determine levels of containment are infectivity, severity of disease, transmissibility, and the nature of the work conducted. Origin of the microbe, or the agent in question, and the route of exposure are also important.

Each biosafety level has its own specific containment controls that are required for the following:

Laboratory practices

Safety equipment

Facility construction

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Risk assessments are conducted by evaluating the way in which the infectious agents or toxin is transmitted and its ability to cause disease, the activities performed in the laboratory, the safety equipment and design elements present in the laboratory

At any given biosafety level, there will be strict requirements for laboratory design, personal protective equipment, and biosafety equipment to be used.

Standard Microbiological Practices are required at all biosafety levels and are good practice for experiments below the BSL-1 threshold.

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Under the laboratory's quality assurance system

Based on QMS17, an external assessment organisation needs to be selected to perform the lab assessment, ensuring that it aligns with lab requirements [2]

Evaluate lab operations to ensure they meet the required standards and regulations

Undergo external audit or inspections that focus on identifying compliance areas

Address any issues identified during the assessment with corrective actions

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Aim: To stop the burning, relieve pain & swelling and minimize risk of infection

1. Running Water & Remove

Flood the injured part with running water (NOT ICE) for at least 10 minutes / until the pain is relieved

Ammonia was splashed into the eye, rush directly to the eye wash station and flush for 15 minutes.

Remove any jewellery, watches, belts, or constricting clothing from the injured area before it begins to swell

2. Cover

Cover the burn with a clean plastic wrap (minimize infection), if not available, use an open weave gauze

3. Monitor

Monitor & record vital signs

Send to hospital

**** NEVER burst the blister as the risk of infection will be higher once it breaks****

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1. Go to an area with fresh air

Go outside the lab to bring in fresh air

2. Continue being in an area away from the ammonia gas while waiting for the arrival of assistance

3. Monitor and record vital signs (heart rate, breathing rate and blood pressure)

4. If fall unconscious, check symptoms to proceed with recovery position, CPR or EAR

Recovery position

1. Support the casualty’s spine and slowly put on their back

2. Place the nearest arm at a right angle

3. Put the back of the other hand next to the cheek closest to you and hold it there

4. Bend the far knee, grasp the far leg and roll them on their side

5. Open airway

CPR

1. Danger - check for danger

2. Response - tap on the shoulder

3. Shout for help - x necessary here

4. Airway - head tilt chin lift, open the airway

5. Breathing - check for breathing and pulse

6. Compression - 30 compressions and 2 ventilation, do 5 cycles and check for breathing

EAR - expired air resuscitation

1. DRSAB

2. Rescue breathe approx 1 sec, each causing chest to rise

3. Give 1 breathe every 6 seconds

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The Recovery Position - First Aid Training - St John Ambulance

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Eye wash station

1. Lab assistants and the student should know where the eye wash is located

2. Must be kept clear and unobstructed

3. Should be flushed by the lab assistant once a week to remove any debris

4. It needs to water flow out evenly from each eyewash head

Emergency shower

1. The valve must activate in 1 second or less

2. Installed at a 10-second distance from the hazard

3. Located in a lighted area and identified with a sign

4. Train workers on equipment use

5. Activate plumbed unit weekly

6. Maintained self-contained units according to the manufacturer specifications

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1. Current intelligence bulletin 59 - contact lens use in a chemical environment. wwwcdcgov [Internet]. 2020 Jul 6 [cited 2022 Mar 4]; Available from: https://www.cdc.gov/niosh/docs/2005-139/

2. QMS17 External Assessments, Audits, and Inspections of the Laboratory.

3. CDC. CDC LC Quick Learn: Recognize the four Biosafety Levels [Internet]. Centers for Disease Control and Prevention. 2019. Available from: https://www.cdc.gov/training/QuickLearns/biosafety/

4. Biosafety Levels [Internet]. Phe.gov. 2019. Available from: https://www.phe.gov/s3/BioriskManagement/biosafety/Pages/Biosafety-Levels.aspx

5. Agency for Toxic Substances and Disease Registry. Ammonia | Medical Management Guidelines | Toxic Substance Portal | ATSDR [Internet]. wwwn.cdc.gov. 2017. Available from: https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=7&toxid=2

6. Zdrazil T. The types of spill kits & when you should use them [Internet]. 2024 [cited 2024 Nov 3]. Available from: https://www.absorbentsonline.com/spill-containment-blog/spill-kits-basics/

7. How to perform fire extinguisher checks in 8 steps? [Internet]. 2024 [cited 2024 Nov 3]. Available from: https://goaudits.com/blog/fire-extinguisher-inspection/#:~:text=Most%20fire%20extinguishers%20have%20a,to%20be%20serviced%20or%20replaced.

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Lack of Immediate Access to Personal Protective Equipment (PPE)
Not wearing appropriate PPE—such as goggles, gloves, and lab coats—leaves individuals vulnerable to chemical spills and splashes. In this case, Sophia did not have sufficient protection for her skin and eyes, making the exposure more severe. Proper PPE minimizes injury risk by acting as a barrier between the individual and hazardous substances.

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Improper Handling of Hazardous Chemicals
Pouring water into a concentrated ammonia solution can increase the risk of splashing, as water added to concentrated chemicals may cause an exothermic reaction. Best practice involves adding ammonia to water slowly, reducing splash potential and heat generation. Without proper handling knowledge, students may unintentionally create dangerous situations.

Inadequate Response to Chemical Exposure
Rubbing her eyes after the splash exaggerated Sophia’s injury, as rubbing can worsen chemical irritation. Proper first-aid response includes immediately rinsing the affected area with water for at least 15 minutes to dilute and remove the chemical. Students should be trained to stay calm and act quickly according to first-aid procedures for chemical exposure.

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Institutional Responsibility for Safety Training
Institutions must prioritize safety training to ensure students are aware of potential hazards and proper response protocols. Comprehensive training on handling chemicals and using safety equipment should be mandatory before students are permitted to work independently. This includes an understanding of Material Safety Data Sheets (MSDS) and emergency response steps.

Laboratory Assistant’s Duty of Care
Laboratory assistants play a critical role in maintaining a safe working environment. In Sophia’s case, the assistant could have offered closer supervision, especially for a student working alone. Assistants should be trained to actively monitor students' adherence to safety protocols and intervene to prevent or promptly manage any incidents.

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Emphasis on Personal Protective Equipment (PPE)
Proper use of PPE is crucial in reducing exposure to hazards. Institutions should provide practical instruction on the selection and use of PPE for specific chemicals, emphasizing its role in minimizing injuries. Regular reminders on PPE protocols can instill the habit of prioritizing safety over convenience or oversight.

Regular Safety Inspections and Accessibility of Equipment
Periodic inspections of the laboratory environment help identify and rectify potential hazards before incidents occur. Ensuring easy access to safety equipment, such as eye wash stations and first-aid kits, should be a priority, as well as clear signage to guide students in emergencies. Inspections reinforce the institution’s commitment to safety.

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Verification of Student Competency Before Laboratory Access
Allowing only knowledgeable and competent students in the lab is essential to prevent accidents. Institutions should evaluate each student’s safety knowledge and skills, ensuring they can safely conduct experiments independently. A verification process, such as quizzes or practical assessments, can aid in filtering readiness for unsupervised lab work.