GB 16371-1996 Occupational chemical skin burns diagnostic criteria and management principles
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National Standard of the People's Republic of China
Occupational Chemical Skin Burns
Diagnostic criteria and principles ofmanagement of chemical skin burnsGB 16371-1996
Chemical skin burns are acute skin damage caused by direct skin irritation, corrosion and heat of chemical reaction of chemicals at room temperature or high temperature, which may be accompanied by eye burns and respiratory tract damage. Some chemicals can be absorbed through the skin and mucous membranes and cause poisoning. 1 Subject content and scope of application
This standard specifies the diagnostic criteria and management principles of occupational chemical skin burns. This standard applies to the diagnosis and treatment of occupational chemical skin burns. 2 Diagnostic principles
2.1 According to the acute skin damage caused by skin contact with a chemical, such as erythema, blisters, and eczema, it can be diagnosed as a chemical burn. 2.2 Certain chemicals such as yellow phosphorus, phenol, hot barium chloride, cyanide, acrylonitrile, carbon tetrachloride, aniline, etc. can also be absorbed through the skin and mucous membranes, and combined with poisoning by the chemicals.
3 Diagnosis and grading standards
3.1 Mild burns: First-degree burns with a total area of less than 10%. 3.2 Moderate burns: A total area of 11% to 30% or a degree of less than 10%. 3.3 Severe burns: Those with any of the following can be diagnosed as severe burns: total area of 31% to 50% or degree of 11% to 20%. a.
Burns with a total area of <30%, accompanied by severe damage to the eyes, esophagus or upper respiratory tract. b.
Burns in special parts such as the head, face, neck, hands, joints, etc., although the area is small, but cause functional impairment, disfigurement, and disability. c.
3.4 The total area of extremely severe burns exceeds 50% or the degree of burns exceeds 20%, accompanied by severe solid organ damage or lower respiratory tract damage. 4 Treatment principles
4.1 Move away from the scene quickly, take off clothes, gloves, shoes and socks contaminated by chemicals, and immediately rinse thoroughly with plenty of running water. The rinsing time is generally required to be 20 to 30 minutes, and the rinsing time should be extended after alkaline burns. Special attention should be paid to the flushing of eyes and other special parts such as head, face, hands, and perineum. After the burn wound is treated with water flushing, reasonable neutralization treatment can be carried out if necessary. 4.2 Chemical burn wounds should be thoroughly cleaned, blisters should be cut off, necrotic tissues should be removed, and deep wounds should be immediately or early incised (sliced) and skin grafted or delayed skin grafting.
4.3 The routine treatment of chemical burns is the same as that of thermal burns. 4.4 Please consult a specialist for diagnosis and treatment when there is eye or respiratory tract damage or chemical poisoning at the same time. Approved by the State Administration of Technical Supervision on May 23, 1996 268
Implemented on December 1, 1996
Labor Capacity Assessment
GB 16371-1996
5.1 For burns on functional parts that cause serious functional impairment of the five senses, motor system or organs, work or rest arrangements shall be made as appropriate. 5.2 For burns on non-functional parts that have no sequelae after healing, they may return to their original positions. 6 Requirements for health examinations
Workers who are exposed to corrosive and toxic chemicals shall undergo pre-employment and regular physical examinations according to the types of chemicals they are exposed to. 7 Occupational contraindications
Same as the contraindications for various chemical operations. 269
A1 New Nine-Point Method
GB16371-1996
Appendix A
Calculation of Chemical Skin Burn Area
(Supplement)
Head and neck area total 9% (of which the front and back sides of the neck each account for 1%). Upper limbs area total 18% (of which the front and back sides of the upper arms each account for 2%, the forearms each account for 1.5%, and the palm and back sides of the hands each account for 1%). Trunk area total 27% (of which the front and back sides each account for 13%, and the perineum accounts for 1%). Buttocks area total 5%. Lower limbs area total 41% (of which the front and back sides of the thigh each account for 5%, the calf each account for 3.5%, and the dorsum and plantar surfaces of the foot each account for 1.75%). Table A1 New Nine-Point Method (Adults)
Head, Neck
Both Upper Limbs
Both Lower Limbs, Buttocks
B1 Three-degree four-division method
Depth classification
Depth of injury
Epidermis
Superficial dermis
Deep dermis
Full-thickness skin, involving
subcutaneous tissue or deeper
Appendix B
Estimation of the depth of chemical skin burns
(Supplement)
Area, %
9(1×9)||tt ||18(2×9)
27(3×9) including perineum 1bzxz.net
46(5×9+1)
Clinical manifestations
Erythema, mild redness, swelling, pain, heat, hyperesthesia, no blisters, dryness and severe pain, hyperesthesia, blister formation, thin blister wall, flushed base, obvious edema with or without blisters, peeling off the epidermis to see slightly moist and pale base, with bleeding spots on it, obvious edema, and dull pain. After a few days, if there is no infection, reticular embolism of blood vessels may appear, waxy white or burnt yellow carbonization, loss of sensation, dryness, edema under the skin, and dendritic vein embolism may appear
The appearance, color and hardness of the skin burned by acid are similar to those of "burned skin". Be sure to pay attention to this feature before deciding to perform a skin removal surgery. B2
B3 The wound surface of sub-alkali burns is moist and greasy, and even skin lines and hair may exist. 270
Chemical substances
Inorganic acids
Hydrofluoric acid
Hydrobromic acid
Organic acids
Trichloroacetic acid
Glacial acetic acid
Chloroacetic acid
Acrylic acid
Inorganic bases
Potassium (sodium) hydroxide
Ammonium hydroxide (aqueous ammonia)
Organic bases
Protoplasmic poison
Protoplasmic poison
Protoplasmic poison
GB163711996
Appendix C
First aid treatment for burns caused by common chemicals
(Supplement)
Cleaning agent
Running water||tt| |Flowing water
Flowing water
Flowing water
Flowing water
Flowing water
Flowing water
Flowing water
Flowing water
Flowing water
Flowing water
Flowing water
Flowing water
Flowing water
Flowing water
Special treatments for reference
5% sodium bicarbonate solution
5% sodium bicarbonate solution
a. 25% magnesium sulfate solution
b. 10% calcium gluconate solution
c. Lime water solution
d. Quaternary ammonium compound-benzalkonium chloride solution soaking, wet compresse. Hydrofluoric acid burn treatment solution\soaking, wet compressing ammonia nitrogen pine vinegar:
1 part of 5% ammonia water
1 part of turpentine
10 parts of 95% alcohol
5% sodium thiosulfate solution
10% calcium gluconate solution
5% sodium bicarbonate solution
5% sodium bicarbonate solution
5% sodium bicarbonate solution
5% sodium bicarbonate solution
5% sodium bicarbonate solution
3% boric acid solution
0.5%~5% acetic acid solution or
10% citric acid solution
0.5%~5% acetic acid solution or
10% citric acid solution
3% boric acid solution
Note: 1) Hydrofluoric acid burn treatment solution; 5% calcium chloride 20 mL, 2% lidocaine 20 mL, dexamethasone 5mg, dimethyl sulfoxide 60 mL. 271
Chemical substances
Ethylenediamine
Ethanolamine
Dimethyl sulfate
Dimethyl sulfoxide
Dichlorophenol
Metal potassium (sodium)
Quicklime
Phosphorus trichloride
Protoplasm poison
Protoplasm poison
Protoplasm poison
Protoplasm poison
Protoplasm poison
Note: 1) Copper sulfate is used as a display agent and antidote. 272
GB 16371--1996
Continued Table C1
Cleaning agent
Running water
Running water
Running water
Running water
Running water
Running water
Running water
Cover with oil
Avoid flushing with a small amount of water
Cover with oil
Avoid flushing with a small amount of water
Cover with oil
Avoid flushing with a small amount of water
Running water
Avoid flushing with a small amount of water
Special treatments for reference
3% boric acid solution||tt| |3% boric acid solution
5% sodium bicarbonate solution
5% sodium bicarbonate solution
a. Wipe the wound with 50% alcohol
b. 5% sodium bicarbonate solution
c. Wipe the wound with cotton or gauze soaked in a mixture of glycerol, polyethylene glycol or polyethylene glycol and alcohol (7:3)
a. Wipe the wound with 50% alcohol
b. 5% sodium bicarbonate solution
c. Wipe the wound with cotton or gauze soaked in a mixture of glycerol, polyethylene glycol or polyethylene glycol and alcohol (7:3)
8. Wipe the wound with 50% alcohol
b. 5% sodium bicarbonate solution
c. Wipe the wound with cotton or gauze soaked in a mixture of glycerol, polyethylene glycol or polyethanol and alcohol (7:3).
3% boric acid solution
3% boric acid solution
3% boric acid solution
8. 1~2% sodium sulfate solution 1
b. 3% silver nitrate solution
C. 5% sodium bicarbonate solution
5% sodium bicarbonate solution
Hepatotoxic poisons
Nephrotoxic poisons
Neurotoxic poisons
Cardiac toxic poisons
GB16371—1996
Appendix D
Toxic substances causing chemical burns and their target organs
(Supplementary)
Yellow phosphorus, antimony trichloride, carbon tetrachloride, nitrobenzene, aniline, ethylenediamine, dimethylformamide, dimethyl sulfate, etc. Phenol, cresol, dichlorophenol, yellow phosphorus, dimethyl sulfate, etc. Gasoline
Soluble barium salt (barium chloride), hydrofluoric acid, oxalic acid Appendix E
Instructions for the correct use of standards
(Reference)
E1 Chemical skin burns are acute skin damage caused by direct skin irritation and corrosion by chemicals at high or normal temperatures and heat from chemical reactions. Flame burns, water scalds and frostbite are not included. E2 When inquiring about the contact history and conducting on-site investigations, attention should be paid to the effects of factors such as the nature of the chemical, contact dose, contact concentration, contact time, contact method, labor protection, personal hygiene, season and flushing time on the occurrence and development of the disease. E3. Chemical skin burns should pay attention to the burn area, degree and location. The burn area is calculated according to the new nine-point method (the area of first-degree burns is not counted). Before estimating the degree of burns and deciding on surgical resection, it is important to pay attention to the morphological characteristics of the wound surface of the first-degree alkali burn and the first-degree acid burn. E4 The diagnosis of chemical skin burns is mainly based on clinical symptoms and signs, as well as the close causal relationship between occupational exposure and the occurrence and development of skin burns. This standard is diagnosed and graded with reference to the National Burn Conference Grading Standard. Although the burn area caused by some chemicals is not large, those who are disabled due to severe local tissue damage should also be considered severe burns. E5 Some chemical skin burns may be accompanied by eye burns, respiratory burns or chemical poisoning. Some poisons such as cyanide, carbon tetrachloride, aniline or hot barium chloride may be accompanied by poisoning or delayed poisoning, which should be paid special attention to and diagnosed and treated according to the diagnostic standards and treatment principles of corresponding chemical poisoning or burns.
Additional Notes:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by Shanghai Chemical Industry Occupational Disease Prevention and Control Research Institute and Ruijin Hospital Affiliated to Shanghai Second Medical University, and was drafted by Shanghai Second Military Medical University, Shanghai Labor Hygiene Occupational Disease Prevention and Control Research Institute, Tianjin Occupational Disease Prevention and Control Institute, Beijing Jishuitan Hospital, Chongqing Third Military Medical University, Lanzhou Petrochemical Company Hospital, and Jilin Chemical Company Hospital. This standard is interpreted by the Institute of Labor Hygiene and Occupational Diseases, Chinese Academy of Preventive Medicine, the technical coordination unit entrusted by the Ministry of Health.
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