To the Editor:
We read with interest the mini-review paper by Jeffrey BrentCitation1 on skin decontamination of chemical splashes. In this review, water appears to be opposed to amphoteric solutions, such as Diphoterine® solution. Diphoterine® solution keeps physical properties of water and, because of its both hypertonicity and amphoteric properties, helps removing corrosive agents from the skin or the eye faster than water rinsing.Citation2 Moreover, it is recommended for eye decontamination in case of corrosive exposures.Citation3
Publications cited in the Brent mini-review underscore the necessity to start decontamination of exposed skin with available flushing fluid as soon as possible. Of course, water “...appears to be efficacious in clinical studies...” versus no or delayed skin decontamination. However, none of these cited hospital-based studies compared water versus more modern alternative, amphoteric flushing fluids, such as Diphoterine® solution.
ANSI/ISEA Z358.1-2009 American National Standard recommends that emergency decontamination showers be located in areas reachable in a maximum of 10 s. We agree that water as a flushing fluid is inexpensive, but is not always available within 10 s and requires expensive installations and maintenance. The above standard lists Personal Wash Units which “shall have the capacity to deliver immediate flushing fluid”. As provided by Laboratoire Prevor, such portable and immediately available Diphoterine® and Hexafluorine® dispensers allow nearly immediate washing, and are viewed by workers as desirable.Citation4 Professor Brent is critical of Donoghue's study, because the Diphoterine® device is used faster than water. Yet, less exposure to the chemical agent and better prevention of chemical injuries is a major advance for workers.
Professor Brent states in his mini-reviewCitation1 that many data suggesting efficacy of Diphoterine® or Hexafluorine® solutions “…were published by individuals from Prevor or have ties with that laboratory…”, perhaps implying that such studies are not as valid as those performed by independent researchers. Prevor researchers contribute to advance knowledge about chemical skin and eye injuries.Citation5 Published clinical data on the efficacy of Diphoterine® or Hexafluorine® flushing fluids (case reports or case series) are usually from independent occupational physicians under their own impetus and responsibility. If ties exist, it is with the firm which employs the occupational physician, not with PREVOR. Published studies by Cavallini et al and Donoghue were performed by independent researchers with no affiliation or financial involvement with Prevor.
Numerous publications underline that water as a flushing fluid is not completely satisfactory and should be improvedCitation6: the water hypotonicity induces a “wash-in effect”, increasing thus chemical percutaneous absorption. Other toxicologistsCitation7 have concluded that the use of Diphoterine® or Hexafluorine® solutions is an improvement over water alone.
Declaration of interest
Authors are researchers employed by Laboratoire Prevor, manufacturer of Diphoterine® and Hexafluorine® solutions.
References
- Brent J. Water-based solutions are the best decontaminating fluids for dermal corrosive exposures: a mini review. Clin Toxicol 2013; 51:731–736.
- Mathieu L, Burgher F, Blomet J. Comparative evaluation of the active eye and skin chemical splash decontamination solutions diphoterine and hexafluorine with water and other rinsing solutions: Effects on burn severity and healing. J Chem Health Safe 2007; 14:32–39.
- Merle H, Gerard M, Schrage N. Severe ocular burns. Eur Ophtalmic Rev 2011; 5:138–141.
- Öberg M, Sjögren B, Boman A, Johanson G. [Irrigation fluids for treatment of acute exposure to hydrofluoric acid and other strong acids and bases. report 2010:6; Overview of current Knowledge]; Arbetsmiljö verket (Swedish), December 2010. Available at: http://www.av.se/dokument/publikationer/rapporter/rap2010_06.pdf. Accessed on 15 October 2013.
- Burgher F, Mathieu L, Lati E, Gasser P, Peno-Mazzarino L, Blomet J, et al. Experimental 70% hydrofluoric acid burns: histological observations in an established human skin explants ex vivo model. Cutan Ocul Toxicol 2011; 30:100–107.
- Chan HP, Zhai H, Hui X, Maibach HI. Skin decontamination: principles and perspectives. Toxicol Ind Health 2012; 1–14. doi:10.1177/0748233712448112
- Nogué S, Amigo M, Uria E, Fernandez F, Velasco V. [Chemical decontamination area in the Emergency Department] Emergencias (Spanish) 2012; 24:203–207.