Consider the Wetterhahn tragedy. A Dartmouth College researcher spills one or two drops of dimethylmercury on her gloved hands while transferring the chemical from a vial to a test tube. Ten months later, she dies. Why?

She had no idea it takes less than 15 seconds for the poisonous chemical to enter her blood stream, break the blood-brain barrier and affect the nervous system. But, even more important, chemistry professor Karen Wetterhahn did not know that the latex gloves she used to protect herself provided no barrier against chemicals as aggressive as dimethylmercury.

What she (and everyone else around her) did not know killed her. OSHA fined Dartmouth College $13,500 for this August 1996 (Wetterhahn died in June 1997) incident, but later reduced the fine because Dartmouth authorities had taken immediate steps to address the issue. Though OSHA blamed the college for not providing adequate training on the use of appropriate gloves, nobody at the time knew the poisoning power of mercury. Here's another case: At Tomasco Mulciber Inc., an automotive parts manufacturer in Columbus, Ohio, more than 60 cases involving crushed fingers triggered an OSHA inspection between July 23 and Dec. 5, 1998, and a subsequent proposed fine of $1.6 million. Reason? Alleged failure to install adequate machine guards on power presses and resistance welding machines and violating lockout/tagout, confined space and electrical standards. More than two-thirds of those who suffered the crushing injuries were temporary untrained workers who made up only one-fourth of the plant's workforce, according to OSHA's allegations.

The plant's safety and health director could not be reached for comment.

Cases like these point out the need to understand why hand injuries occur and how to protect hands. Hazard assessments, management commitment, training, rules and procedures, personal protective equipment, machine guards, ergonomic solutions and barrier creams and lotions can all be part of the solution.

Types of hand injuries

What's a hand worth?

The National Safety Council reports that data published by the National Council on Compensation Insurance shows that average lost-time workers' comp claims are $12,006 for arm and wrist injuries, and $7,460 for hand or fingers.

The average direct cost of a laceration is $1,100, the indirect cost, $5,000, according to Jeff Hoberg, director of marketing at Wells Lamont Industrial Products in Niles, Ill. "The more people realize the 'severity' of the [direct plus indirect] cost, the more it will help them," he says.

Why do hands get hurt?

• Some workers simply don't wear any protection. "People take safety precautions for granted," says Larry Garner, president, Memphis Glove Co. in Memphis, Tenn. "They resist taking the time to incorporate safety into their daily routine - call it laziness or bad habit - and sometimes it can be too late."
• Some wear the wrong PPE because they either do not know, or they have not been trained to choose the correct glove for the job. Hoberg says employees working with sheet metal have been seen using cotton jersey gloves when they should be wearing the cut-resistant type.
• Lack of training about glove type and function is a major reason for selecting the wrong PPE for a job, our experts say.

  With so many areas of protection to consider, a safety supervisor may not have all the specifics on the most appropriate glove for the job, explains Craig Wagner, director of international sales for Best Manufacturing Co. in Menlo, Ga.

  Different types of gloves offer varying degrees of cut resistance, puncture resistance, abrasion protection, protection from heat and cold, chemical resistance, viral penetration, dexterity, liquid-tight integrity, and flame and heat resistance. Employees might not be aware that there are consequences to making the wrong choice. Responsibility for choosing the correct type of glove, or for that matter any PPE, is a "shared one" between the safety and health supervisor and the individual, says Garner.

• Wearing/using PPE incorrectly can be another reason for hand injury, says Pam Henson, marketing manager for Debus/SBS in Stanley, N.C. "Protective creams are meant to be rubbed completely onto your hands, between the fingers and over your wrists, depending upon your work situation." If you don't, she says, it gives you a false sense of security.
• Carelessness and a rush to complete the job also invite hand injuries. Workers doing the same job day after day tend to "take shortcuts," explains Bill Figard, senior product manager for North Safety Products in Charleston, S.C. Risks are increased when employees are doing multiple jobs with the same glove - which may not be designed for all the tasks performed.

  Carelessness and behavioral problems when using exacto knives to trim molded parts were a major cause of hand injuries among workers at Scientific Technologies, Inc., in Fremont, Calif., according to Jim Ashford, vice president of operations. Ashford, who heads the company's health and safety department, says the pressure to produce a certain amount of work contributed to the haste and carelessness until the company designed a tool for the job and "took the hands out of the process." As a result, in 1998, STI saw only two hand injuries.

  Poor work practices can also cause hand injuries, according to Frank Perry, health and safety director at Cameron in Houston, Texas. Describing an incident which occurred while servicing a blowout preventer (BOP) on an offshore oil well, he says, "One employee called for the operator to cycle the BOP at the controls (when the operator and the employee could not see each other) . . . and then placed his hand between two moving parts to wipe off some fluid." Naturally, his hand was severely lacerated.

• It's not a question of the employer not providing PPE, "it's about worker acceptance," says Bill Alico, director of sales and marketing at Perfect Fit Glove Co. Inc. in Buffalo, N.Y. Workers who have been doing the same job for years without receiving a scratch may not wear a glove because it is uncomfortable or does not fit right, and then, all of a sudden they are taken by surprise.
• Last but not least, "the root cause of hand injuries can be traced to the initial hazard analysis," says Jim Larson, chairman, Protective Clothing and Equipment Committee, American Industrial Hygiene Association, and regional health and safety manager for Dames & Moore in Denver, Colo. Without thorough investigation and analysis to determine the hazards and the correct PPE for those hazards, the possibilities for hand injuries increase substantially, he says.

Tips for protection

1. Conduct a thorough hazard investigation and analysis of the workplace to determine appropriate engineering controls, work practices, use of skin care products and hand protection PPE for the jobs performed. Eleanor Fendler, research scientist and manager of product development at GOJO Industries, Inc., in Akron, Ohio, says, "Selection of the correct skin care regimen requires an assessment of workplace conditions and the effect of such conditions on the skin - levels of damage, type and degree of soiling, and the frequency with which such soiling needs to be removed."

2. Train your employees on:

• how to select the right glove. Keep in mind the nature of the job, the glove material and the duration of contact with the chemical or harmful substance. Experts suggest consulting manufacturers' glove selection guides or calling the manufacturer for advice.
• how to wear and use gloves and other PPE so they fit correctly and comfortably. Correct fit and user comfort are critical for the glove to afford the degree of protection it is designed for and enable the employee to do the job well. Store gloves in a couple of different sizes and styles so workers can choose the one that fits their hands and the job, recommends Ansell's Morris.
• how to remove and store gloves and creams/lotions after the task is done. Without proper storage, gloves, may lose their effectiveness by getting soiled or torn. Also, the care and use of reusable gloves is different from that of disposable gloves. Consult the manufacturer for information.

3. Employees should know that:

• all gloves are permeable depending upon the chemical handled and the extent and duration of contact; the most expensive glove is not necessarily the best glove for the job, experts say. Though you do get what you pay for, according to Larson, the point is to choose the right glove for the task. Sometimes cheap gloves that can be disposed of after each use are more economical and safer to use. Disposing of the glove reduces chances of contamination.
• gloves can actually become a hazard on some occasions. When they are too tight they restrict circulation; when they are too loose they run the risk of getting caught between moving machinery parts. At Cameron, machinists are prohibited from wearing gloves during the machining process because it presents more of a hazard, says Perry. "Instead, we provide them with 'shavings hooks' to reach and pull the shavings out while keeping the hands at least two feet away from the rotating machine tool and the sharp shavings," he explains.
• you cannot always use the same glove for multiple tasks. Check manufacturers' recommendations.

4. Retrain employees whenever there is any change in the production process.

5. "Put up posters wherever possible to educate employees about which gloves are appropriate for which task," says Michael Blayney, director of environmental health and safety at Dartmouth College in Hanover, N.H.

Following the death of Dr. Wetterhahn, Blayney does not count on employees and students to remember the safety message from the first time they hear it. He repeats it over and over through posters placed strategically in labs and in all areas that require the use of PPE. Posters describe the protective abilities of the various types of gloves and remind users that all gloves are permeable and that there is no such thing as the "ideal chemical-resistant glove."

Students, professors and other college personnel handling corrosive and aggressive chemicals like dimethylmercury are advised that "sometimes the ideal glove is actually two gloves worn together," - for example, flexible laminate gloves such as Silver ShieldU or 4HU should be worn under a reusable neoprene glove.

6. Analyze accident reports thoroughly, says Gualardo of Niagara Mohawk. He slices and dices the reports in numerous different ways to learn the cause of hand injuries and how he can prevent them.

7. Make the donning of PPE a condition for the job, says Larson. Verbal or written warnings and reprimands are in order when safety rules and procedures are broken.

8. Finally, it's not enough to simply teach or train employees on the technical aspects of PPE if your goal is to reduce hand injuries long term.

"You need to communicate to your people an appreciation for using personal protective equipment," Larson emphasizes. "Ingrain it into them, don't just enforce it." Share accident statistics and real world examples to create awareness of the risks and consequences.

Sidebar 1

The Injury Toll Every day more than 1,100 serious injuries occur to workers' arms, upper arms, elbows, forearms, multiple arm(s) locations, wrists, fingers and hands, according to OSHA. In 1996, 425,649 injuries put employees out of work.

• Arms: 80,153
• Wrists: 94, 954
• Hands except fingers: 75,610
• Fingers and finger nails: 152, 585

Among all industries, manufacturing reported the highest number of cases followed by wholesale and retail.

Incidence rate per 10,000 workers

• Upper extremities 50.7
• Arms 9.5
• Wrists 11.3
• Hands 9.0
• Fingers and fingernails 18.2

Leading causes of hand injuries

Hand