|Bureau of Epidemiology|
|Bureau of Epidemiology||December 2000||Utah Department of Health|
Burn Surveillance in Utah, 1998
FDA Orders Safe Handling Labels for Shelled Eggs
Monthly Morbidity Summary
Burn Surveillance in Utah, 1998
Burn injuries represent a major complaint for patients presenting to emergency rooms in the US, with over a million visits annually. While the majority of burn injuries are not life-threatening, major burns have a significant risk of mortality and morbidity. Less significant burns still carry a real risk of scar formation and compromise of function.
The Environmental Epidemiology Program (EEP) of the Utah Department of Health has established a work-related burn injury surveillance program to track the number and type of burns occurring to Utah workers. This information is analyzed, and is used to develop intervention strategies to reduce the number of work-related burn occurrences.
The statewide surveillance project is the only system in Utah dedicated to collecting data and tracking injuries associated with work-related burns. Intervention activities to prevent burns include education and consultation with employers where burn hazards are present and education for work-related cases and workers in general. Survey results from work-related burn cases indicate that 83% of the accidents were preventable in the opinion of the injured person, and 50% of those burned performed the task related to the burn daily and eight percent had never before performed the task. These statistics indicate that there is a need for focused work-related burn intervention strategy in the state.
Hospital discharge data was received by the Utah Department of Healths, Bureau of Epidemiology under the authority of the Utah Injury Reporting Rule (R386-703). The Injury Reporting Rule requires that injuries be reported by hospitals to the Bureau of Epidemiology. Patient records containing one or more International Codes of Diagnosis, 9th Revision, Clinical Methods, (ICD-9) codes attributed to burns were then evaluated to determine if the burn injury was work-related.
Work-related burns can be divided into three causal categories: thermal, chemical, and electrical. Thermal burns are caused by contact with hot objects, flames, or steam. Chemical burns are caused by contact with acids or bases. Most acids produce a coagulation necrosis by denaturing proteins and forming an eschar that limits the penetration of the acid. Bases typically produce a more severe injury known as liquification necrosis which does not limit tissue penetration. Electrical burns are infrequent, but can cause major damage. During 1998, Utah hospital discharge data reported to the Utah Department of Health indicate that 67% of work-related burns were from a thermal source, 23% from a chemical source, and 10% from an electrical source.
The EEP examined the incidence of hospital admissions attributed to work-related burns that occurred in the state of Utah in 1998. During 1998, hospitals throughout Utah reported 270 hospital admissions that were attributed to burns. Of these reported burn-related injuries, 57 cases were work-related and 213 were non-work-related. The incidence of work-related burns in Utah for 1998 is 5.4 (Male: 9.1; Female 1.8). Incidence rates (crude) were calculated per 100,000 population and are based on Utahs 1998 total workforce population. The incidence for work-related burns is significantly higher among males than females, and relative to age groups, persons 20 - 24 years of age demonstrated the highest incidence of work-related burn injuries (Table 1).
Salt Lake County accounted for 44% of the total workforce population and was the largest contributor to work-related burn injuries accounting for just over 60% of the burns. The counties demonstrating the next highest percent occurrence of work-related burns include Utah (8.7%), Weber (7.0%), and Tooele (5.2%) counties. Twenty-five per cent of the workforce population was accounted for in Utah (15.0%), Tooele (1.1%) and Weber (9.1%) counties. The remaining counties accounted for 18 percent of the work-related burn injuries and 30 percent of the workforce population, respectively. There was one fatality attributed to work-related burns and two work-related cases were burned to the extent that they are permanently disabled.
Using the Standard Industrial Classification (SIC) code, as established by the U.S. government, results of data collected in 1998 also indicate that the highest percentage (29%) of work-related burns occurred in Eating Places (SIC 5812). The majority of cases were related to contact with hot food or beverage, or contact with the equipment used to cook food and/or beverages. Eight of sixteen, or 50% of these cases were 25 years of age or younger. Nineteen percent of the burns (SIC code 5812) were 21 years old and younger. The second highest percent of work-related burns (7.3%) occurred in the Smelting and Refining Industry (SIC 3339). Four other industries including Steel Works (SIC 3312), Electrical Services (SIC 4911), Building Cleaning & Maintenance (SIC 7349), and Medical & Surgical Hospitals (SIC 8062) each accounted for 3.6% of the work-related burns reported. The remaining work-related burns occurred in twenty-seven different industries (Table 2).
Ninety-three percent of those surveyed indicated that they were employed full-time when burned. Seven percent were part-time employees. December was the month most likely for a work-related burn to occur (19%), and Monday and Saturday were the most likely days (21% each). Sixty percent of the reported work-related burns occurred between the hours of 7:00 a.m. and 3:00 p.m., the traditional day shift. Forty percent of the work-related burn cases occurred to those who had completed high school only, as compared to 13% who had completed high school and went on to graduate from college. Most accidents involved only one person (85%) and occurred inside a building (75%). Eighty-three percent of the cases reported that in their opinion, the burn accident could have been prevented, and 64% stated that they were aware of a written set of safety rules provided by the employer.
The Food and Drug Administration recently issued a regulation to improve food safety as it pertains to eggs. The regulation will require shell egg cartons to bear safe handling instructions because of eggs association with Salmonella enteritidis (SE). Approximately one out of every 20,000 eggs produced in the United States is estimated to be contaminated with Salmonella enteritidis. SE outbreaks have been linked to undercooked eggs served in homes as well as commercial establishments. Several outbreaks in Utah have been attributed to undercooked eggs or foods containing undercooked eggs.
Persons infected with SE may experience diarrhea, fever, abdominal cramps, headache, nausea and vomiting. Following safe egg handling practices is important for all consumers, but is especially important for those most vulnerable to foodborne disease- children, the elderly, and persons with weakened immune systems who could develop severe or even life-threatening illness. The required statement will appear as follows:
SAFE HANDLING INSTRUCTIONS: To prevent illness from bacteria: keep eggs refrigerated, cook eggs until yolks are firm, and cook foods containing eggs thoroughly.
The rule also requires that eggs be refrigerated promptly at 45 degrees Fahrenheit or lower upon delivery to retail establishments including supermarkets, restaurants, caterers, hospitals, nursing homes and schools. Refrigeration at temperatures of 45 degrees Fahrenheit or cooler slows the growth and development of SE.
This rule is one part of the larger Egg Safety Action Plan which was announced by President Clinton on December 11, 1999. The plan, a joint effort by the FDA and the Department of Agriculture, seeks to reduce by 50 percent the number of SE illnesses attributed to contaminated eggs by 2005 and eliminate egg-associated SE illnesses by 2010. The refrigeration requirement will be effective in 6 months, while the safe handling requirement will be effective in 9 months.
of Diseases of Low Frequency Year to Date,
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Utah Department of Health,
Bureau of Epidemiology
The Epidemiology Newsletter is published monthly by the Utah Department of Health, Division of Epidemiology and Laboratory Services, Bureau of Epidemiology, to disseminate epidemiologic information to the health care professional and the general public.
Send comments to: The Bureau of Epidemiology, Box 142104, Salt Lake City, UT 84114-2104, or call (801) 538-6191
Approval 8000008: Appropriation 3705
Rod Betit, Executive Director, Utah Department of Health