Inspection Detail

Inspection: 119825370 - Lonza Inc

Inspection Information - Office: Long Beach District Office

Investigation Summary

At 6:00 a.m. on August 3, 2002, Employee #1, a chemical engineer with 7 years of experience with Lonza, Inc., a manufacturer of pharmaceutical products, arrived at the 3,000 gallon capacity RV-5 and was briefed by the night shift operator on the status of the ATHAEt oximation reaction process. He told Employee #1 that the system had just completed the transfer and the next step was to remove the pH probe for cleaning and calibration. Employee #1 questioned him about the centrifuge step and the operator reviewed it with him. The oximation step was already completed and the night shift operator had transferred the process material and rinse water from RV5 to the 4,000 gallon RV-10. The pH of the process solution was maintained at approximately 2.0 during oximation reaction. After briefing Employee #1, the night shift operator left the site. At approximately 6:15 a.m., Employee #1 released the clamp holding the pH probe in place on the recirculation loop of RV-5. As a result, the internal pressure in the system pushed the pH probe out of the port and the process solution sprayed out onto his face, right arm, shoulder, and torso. He put the probe down and went to the eyewash/emergency shower, approximately 20 ft away. On the way, he noticed that the nitrogen valve used to push the rinse water to R-10 was half open. He turned it off and continued to the eyewash station. He rinsed his face for between 5 and 8 minutes, then went to the locker room, removed his shirt, and wiped himself off with wet towels. As Employee #1 was changing into new clothes, a coworker noticed that his eyes and shoulder were red and irritated. The coworker took Employee #1 to the U.S. Health Works, where he was treated and released. Later that same day, he noticed blisters under his arm and went to the Whittier (CA) Presbyterian Intercommunity Hospital, where he was admitted for two days. Employee #1 was then transferred to Torrance Memorial Hospital, where he was treated for another week. A doctor's report indicated corneal abrasion on his right eye and chemical contact dermatitis on his right chest. Employee #1 was wearing a uniform, gloves, safety glasses, hardhat, and safety shoes at the time of accident. The accident was caused by Employee #1's failure to relieve the internal pressure in the system to prevent a sudden pressure release. This caused the process solution to spray out before Employee #1 removed the pH probe, which would have opened the closed system.

Keywords: EYE, WORK RULES, TORSO, HIGH PRESSURE, FACE, ACCIDENTAL DISCHARGE, COMMUNICATION, CHEMICAL