UNITED STATES
DEPARTMENT OF LABOR

Abstract: At approximately 2:50 p.m. on March 3, 2010, Employee #1, a plumber, was working with a coworker installing new furnaces and AC units at an apartment complex. The furnace and AC units were all the same design and configuration. They were flushing the existing .375 in. diameter copper lines of R22 refrigerant oil residue in preparation for the new 410 refrigerant. The coworker was outside injecting the flammable liquid solvent into the line, and Employee #1 was inside the apartment reclaiming the cleaning solvent mixture utilizing a plastic coffee container. During this process, the vapors from the solvent ignited (flash fire), and the employee sustained second and third degrees burns to 80% of his body. Employee #1 died several hours later at a local Hospital. It was believed that the flash fire was a resulted from static as the liquid was discharging out of the copper line into the plastic coffee can. Cleaning the lines involved one person injecting a combination of "Virginia 10" solvent and nitrogen into the existing copper lines using a "Pro-Flush" injection system from the exterior of the structure and a second person on the inside to reclaim the product at the end of the lines. The "Pro-Flush injection cylinder contained approximately 24 oz of the "Virginia 10 (Class IB flammable liquid) degreasing solvent and an unknown quantity of nitrogen. The "Pro-Flush" injection system was purchased from a vendor who was selling products to plumbing companies for use in complying with the new EPA rules for R410 refrigerant. The "Pro-Flush" device was originally purchased by the company and included a can of nonflammable solvent. The employer decided not to use the solvent originally purchased with the system and began to use the Virginia 10, recommended by another company selling the products for plumbers to be used for cleaning refrigerant lines being converted to R410 refrigerant.