Water Safety: New Directions in Irrigation and Hydration

While it may have no immediately visible outward signs, dehydration contributes to lower performance and decreased workplace safety.

Workplace safety is a major concern of every employer — more now than ever before. Through the years, stringent regulation and an ever-growing concern for the health and well-being of employees have brought advancements in processes, safety procedures, and first aid protocols to treat the injured. This movement has had a profound impact on emergency equipment, including eye irrigation and personal hydration.

Eye Irrigation Advancements

During the first half of the 20th Century, the commercial eyewash as we know it today was invented. Urban legend has it that the first "steady stream" eyewash was devised back then by an industrial plant manager. He was so concerned about his employees' welfare that he adapted the use of two drinking fountain bubbler heads and valves mounted on opposing sides of a sink. When activated, the streams formed a double arch that aimed water from the outer perimeter of the sink to its center. An injured victim would place his face into the double streams and irrigate both eyes simultaneously.

It was a great concept and one that took the safety industry to a new level during the ensuing 50+ years. Except for one thing: Irrigating with streams that contact the eye at its outer canthus, or corner, and flow inward toward the nose is diametrically opposed to the way we health care professionals irrigate eyes. Using laminar flow design in the eyewash streams acknowledges this and results in a flow with an absence of turbulence because the stream is "built" in layers. Turbulence or inconsistencies in the flow stream can strike the eye as a change in total pressure, making the victim much less comfortable with the process. The best approach is providing an even, comfortable, predictable stream height and circumference, accomplished by using laminar design principles.

The protocols and practices of emergency equipment providers are changing. Irrigating eyes in a manner that is consistent with medical procedures is not only the right thing to do, but also it shows that as physicians we care about our patients' comfort and are proactive in our quest to employ the best techniques and products available to us. By providing progressive and innovative techniques, we are guaranteeing the increased safety of the workforce.

Personal Hydration Advancements

At the same time, one of the contributors to lower worker performance and in turn decreased safety has no immediately visible outward signs. Physical dehydration can be insidious and, depending on each individual's state of hydration and tolerance level to thirst signals, it can have a profound impact on your business.

Recently, the detrimental effects of personal dehydration have begun to come into focus in the industrial environment. A growing body of evidence points to dehydration as one of the most widespread and least understood hindrances — and dangers — on the job. Let's consider some facts:

  • A number of studies have been done over time linking dehydration to lower physical and mental performance: For example, Wasterlund and Chaseling1 studied forest workers in a controlled environment, where one group was properly hydrated and the other dehydrated to an extent of about 1 percent of body weight loss. The measure was the time required to debark and stack 2.4 cubic meters of pulpwood. The result was a 12 percent decrease in productivity from the dehydrated group.

    Many more studies attained comparable results. With respect to mental performance, Gopinthan et al.2 studied the effects of dehydration on decision-making and cognitive performance, finding the resulting decline in productivity could be associated with an increased risk of work-related accidents. In this study, subjects were passively dehydrated to 1, 2, 3 and 4 percent of body weight with specific testing throughout the decline. The study concluded that visual motor tracking, short-term memory, attention, and arithmetic efficiency were all impaired at dehydration levels of 2 percent of body weight or more. In the extreme, the Gopinthan study also noted a 23 percent reduction in reaction time when subjects were 4 percent dehydrated.

  • It's been estimated that up to 80 percent of the U.S. adult population goes through its normal day in at least a mildly dehydrated state. And if one reports for work dehydrated, the odds of that circumstance improving during the day aren't very good.

  • When an employee is performing physical work, sweat output can easily outpace water intake, which leads to dehydration. And more severe working conditions can accelerate dehydration: Bishop et al.3 observed that fully encapsulated protective clothing increased sweat rates up to 2.25 liters per hour. In the simplest of terms, what fluids leave the body must be replaced, or dehydration is inevitable.

  • Finally, evidence from several studies seems to indicate dehydration may be linked to job-related accidents by causing "orthostatic intolerance." Adolph4 noted dehydrated subjects fainted more quickly when subjected to an orthostatic challenge test (a change in body posture). Similarly, Carter et al.5 established that at a 3 percent dehydrated state from heat exposure, subjects experienced a significant reduction in cerebral blood flow velocity when changing from a seated to a standing position.

Assessing Hydration Status

Assessing an individual's state of personal hydration is difficult because there is no accepted definition of normal body water status, nor is there a logical measure for water intake in the absence of such a targeted quantification. In combination with water intake habits and thirst tolerance, it all adds up to a significant problem that is amplified in warmer climates and seasons. The conventional wisdom of "eight glasses a day" doesn't hold water (pun intended) when one considers the wide variety of body sizes, shapes, states of wellness, and the level of outside influences to which each individual is subjected daily.

Assessing urine color, although it has limitations, is one of the best methods of superficially monitoring hydration. This obviously personal assessment certainly involves the individual employee's commitment and best intentions.

Improving overall employee hydration is best accomplished through the use of a three-pronged approach including education, assessment, and implementation of best practices of encouraging fluid intake during the work day.

Education: The most critical component is employee involvement. The personal benefits of proper hydration span all facets of a person's life. The cognitive and performance-based advantages gained from good hydration at work will be available, obviously, after work, as well. From an employee's perspective, proper hydration involves a decision to improve and the determination to make assessing his hydration state and staying hydrated habitual.

Companies should make hydration education an ongoing part of employee communications. There are many courses and training guides available to stress hydration to various levels of employees. Likewise, reminders posted throughout the facility are an important part of the equation, as well. Posters, signs, and verbal reminders should be consistent and ongoing.

Employees also should be made aware of the downside of drinking soda and coffee in the interest of hydration. Both usually contain caffeine, which is a diuretic that will act to further dehydrate the body even while the person drinking it may think she is alleviating dehydration. Any sugar content further taxes the body due to its processing demand, again serving to dehydrate. These and other pertinent facts should be reinforced consistently through training and visual reminders.

Assessment: Employees truly have to embrace the quality-of-life enhancements available to them through better personal hydration in order for this change in behavior to happen and remain in place. It simply can't be a job requirement. It's a lifestyle change, in many instances, and that change includes becoming highly conscious of the assessment requirement. The best way to assess hydration status, given the variables of body mass, work routines, and other environmental and personal issues, is to monitor urine color. Urine that is clear to light yellow is a reasonable indicator of proper hydration. However, heavy consumption of water to overcome darker color urine can "falsely" lighten subsequent urinations, as it may take up to 24 hours for the body to assimilate sufficient additional fluids to fully rehydrate itself. The key is consistent hydration and consistent assessment; with these, urine color becomes more stable and monitoring becomes much more accurate. Again, this should all be part of the ongoing education program. Local hospitals usually have dietitians or other professionals on staff who will be eager to help build your educational and reminder programs.

Implementation: The critical third facet in the hydration plan is making drinking water very readily accessible and appealing. While plumbing codes mandate the availability of drinking fountains in commercial buildings, they do not cover maintenance or water quality issues. With respect to maintenance, consider your own personal acceptance of drinking fountains in your workplace: Are the facilities for providing drinking water inviting enough for you to use them regularly?

Don't forget that you are going to be asking employees to use these facilities much more frequently than ever as part of your increased hydration initiative. How does the water taste? One of the main reasons for the explosive growth in bottled water sales during the past 10 years is the fact that many people object to drinking chlorinated tap water. Again, you will be asking people to drink much more than they have in the past, so the sanitary condition of the fountain or cooler and the taste of the water that it dispenses are of paramount importance.

Many companies have moved to bottled water over the years. While that approach can certainly encourage hydration, it is both expensive and environmentally insensitive. In the United States alone, we use 50 billion small (half-liter) bottles of water each year and place between 30 and 40 billion of those containers in landfills. Bottled water may handle the access-to-acceptable- water issue, but it will inevitably create another problem down the line.

Consider upgrading your existing installed drinking fountains with advanced products that encourage use and can become an active part of your hydration reminder program: chilled water, filtered to remove the chlorine taste, with enhanced low-maintenance features to allay sanitary fears.

In the end, supporting and encouraging employee safety through advanced irrigation and hydration techniques is an initiative that can have significant impact on your company's overall performance and safety record, as well as the general welfare and health of your staff. It requires a firm commitment on the part of management, complete buy-in from employees who will be asked to alter their past habits, and continuous positive reinforcement from all involved.

References

    1. Wasterlund DS, Chaseling J, Burstrom L. “The effect of fluid consumption on the forest workers’ performance strategy.” Appl Ergon 35:29-36, 2004.
    2. Gopinathan PM, Pichan G, Sharma VM. “Role of dehydration in heat stress-induced variations in mental performance.” Arch Environ Health 43:15-17, 1988.
    3. Bishop PA, Pieroni RE, Smith JF, Constable SH. “Limitations to heavy work at 21 degrees C of personnel wearing the US Military chemical defense ensemble.” Aviat Space Environ Med 62: 216-220, 1991.
    4. Van Loan M. “Age, gender, and fl uid balance.” In Buskirk ER and Puhl, SM. (eds): Body Fluid Balance: Exercise and Sport. Boca Raton: CRC Press, 1996: 215-230.
    5. Carter R 3rd, Cheuvront SN, Vernieuw CR, Sawka MN. “Hypohydration and prior heat stress exacerbates decreases in cerebral blood flow velocity during standing.” J Appl Physiol 101:1744-1750, 2006.

 

This article originally appeared in the September 2009 issue of Occupational Health & Safety.

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