Hydraulic Injection Injury: Why It's Dangerous and How to Avoid It

You're repairing a hydraulic system one day when you suddenly feel a sharp stinging pain through your work gloves. You rip off the glove and take a look – there's a small puncture wound but it doesn't really hurt. You finish the repair and clock out.

By the time you're getting ready for bed, the area around the puncture is a little swollen and painful. You wake up in a fair amount of pain and go to an urgent care clinic, just to be safe. They prescribe antibiotics and pain meds.

Over the next few days, the problem only gets worse. The pain meds don't help. Eventually, you end up at a hospital with a surgeon saying may lose the use of your hand. They schedule an emergency procedure but they may need to amputate a finger.

That's when you find out you weren't pricked by a bit of metal or sharp plastic – you sustained a hydraulic injection injury.

What is a Hydraulic Injection Injury?

A hydraulic injection injury happens when your outer layer of skin is broken by a jet of fluid under pressure. It's sometimes referred to as a hydraulic oil injection injury, hydraulic fluid injury, or high-pressure injection injury.

"Injection" brings a needle to mind, but any high-pressure fluid stream can penetrate the skin without help. It may take as little as 100 psi to break human skin, and most high-pressure systems keep fluids at 2000 psi, minimum.

Why is a Hydraulic Fluid Injury So Dangerous?

Some hydraulic fluids are toxic, which is a problem of its own. But the high-pressure injection of any fluid can result in severe injury or death.

Why? Because it often goes untreated until it's too late.

To the injured person, a high-pressure injection may only feel like a slight sting or prick. Minor scrapes and cuts are a routine part of their job, so they often wait until they're in severe pain to seek help.

Even if you seek immediate treatment, many doctors won't recognize the threat. The injury is rare and looks like a simple puncture at first. Few doctors would guess you need immediate surgery, especially if you never mention hydraulic equipment.

By the time most patients get the right kind of care, the high-pressure fluid has cut off blood supply to the point of permanent muscle and nerve damage. It's called compartment syndrome, and the problem spreads until you have surgery to relieve the pressure and clean out dead tissue.

What looks like a pinprick on a fingertip can lead to the loss of a finger – or two, or a hand, if you wait.

Who is At Risk of Hydraulic Injection Injury?

Anyone who works with or near a system with high-pressure fluid can be at risk.

However, the biggest danger happens during a malfunction or breakdown, particularly when a mechanical or material failure doesn't compromise the system pressure.

According to a study by the Fluid Power Safety Institute (FPSI), "more than 99% of people who service, repair, and troubleshoot hydraulic systems have been subjected to the exact dynamics that trigger a high-pressure injection injury." The stream just didn't hit skin.

In other words, there are a lot of near misses, even though the injury is rare.

The most common hydraulic fluid injuries come from grease guns, paint sprayers, and pressure washers. Fuel injection systems also present a risk, and so do pinhole leaks in pressurized hydraulic lines.

How Do You Prevent a Hydraulic Oil Injection Injury?

First, it's important to know that even the heaviest gloves can't protect you. There isn't a work glove on the market that can withstand the pressure of a hydraulic system.

The best practice is to deactivate hydraulic equipment to a zero energy state before you inspect or work on it – in other words, to follow lockout/tagout (LOTO) procedures.

Short of LOTO, there are a few things you can do to minimize the chance of a hydraulic fluid injury:

• Never use a hose that could be defective or one that isn't rated for the required pressure.
• Depressurize the system before you disconnect lines, loosen or tighten connectors, or do any work that could result in a fluid stream.
• Inspect nipples, adapters, connectors, and other components subject to high pressure at regular service intervals.
• Replace fittings only with parts that are compatible with OEM specifications.

If you're trying to find a leak on a pressurized hydraulic system, remember that:

• You should never use your hands to feel for a leak. Only place an object like cardboard, wood, or metal in the path of a potential leak, with a long enough reach that no body part is at risk.
• The source of a leak can be very small you can't see the stream directly and only know it exists because fluid is accumulating. That stream still presents a high-pressure injury hazard.
• The leak may be hidden by other components, so be careful when moving things around – the fluid stream could hit you unexpectedly.

Employers with workers at risk of high-pressure injection injury should take proactive measures. Ideally:

• Spread awareness of hydraulic injection injury to those who are at risk. It's easier to educate those at risk than expect doctors to diagnose a rare and unusually dangerous injury.
• Determine which local hospitals are appropriate for such an injury – ultimately, you'll need access to a surgeon (probably a hand surgeon) familiar with treating compartment syndrome, and you want to minimize the number of hoops to get to one.
• Have "Dear Doctor" packets prepared so you can quickly assemble the needed information, including when the injury happened, the type of fluid, at what pressure. Store the form with one copy of the Safety Data Sheet for each pressurized fluid in your workplace so you can quickly grab the right one and go.

What Do You Do If You Suspect a Hydraulic Injection Injury?

If there's any suspicion that you or someone you know has sustained a hydraulic injection injury, they need to go to an emergency room immediately. Serious damage begins within four to six hours of the injury, and it's going to take that time to get diagnosed and into surgery.

Don't bother with urgent care or a general practitioner. You need an ER at or affiliated with a trauma center. Not all hospitals offer inpatient surgery.

Things to consider on your way to the hospital:

• Do NOT apply a tourniquet.
• Applying an ice or cold pack may minimize swelling but it won't really "buy time."
• If there are multiple hospitals in the area, go to the biggest/most advanced hospital available.
• Have the name of the chemical ready for the doctor, as well as the pressure at which it was injected.

Make it clear that you suspect a hydraulic oil injection injury or hydraulic fluid injury. Insist that you need to be treated quickly and aggressively – studies have made it clear that immediate surgical intervention is required.

Be prepared for the possibility that the receiving doctor or nurse won't know how serious the injury can be. Remember, this is rare – even renowned specialists only see one or two cases a year. Explain that high-pressure fluid may have been injected into your tissue, and if that's true, you need surgery as quickly as possible.

A simple physical exam may not be able to confirm it's a hydraulic fluid injury. Insist on a CT scan or at the least an x-ray – those results aren't 100% but they'll catch trauma missed by a physical exam.

If you're not taken seriously by receiving staff, make yourself a nuisance or go to another facility. It's your hand at stake.

Bottom Line

Occupational safety hazards aren't always intuitive or obvious by themselves. Education can give you the information to avoid a devastating injury. That's why OSHA requires awareness training for the potential hazards in your workplace.

Safety classes don't have to involve stuffy classrooms and 8-hour sessions. We're an OSHA-authorized online training provider with a large catalog of safety and health courses. You can set your own pace and learn from anywhere with an internet connection.

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