The pressure’s on

Cleaning specialists using water jetting are being urged to follow new injury management guidelines. David Kennedy, Director of the Water Jetting Association, explains why.

Water jetting is used thousands of times a day across many industries and commercial premises for surface cleaning and de-fouling. The technology provides a fast and highly effective way for cleaning operatives to tackle multiple layers of grime, oils, hard-to-shift organic material and graffiti.

Associated risks have been known for a long time. In particular, there is a concern about injuries caused when water penetrates the skin, a process known as fluid injection.

Fluid injection can occur at water pressures as low as 40 bar (580 pounds per square inch), far lower than many over- the-counter pressure washers used by cleaning specialists across the UK. Ultra-high-pressure water jetting can exceed 2,500 bar, or 36,259 psi.

This ever-present risk is a key reason the Water Jetting Association (WJA) commissioned a team of eminent medical professionals to carry out research aimed at updating our understanding of water jet injuries, and how they need to be managed.

paramedics and hospital emergency teams now have clear step-by-step guidance on the treatment of water jet injuries.

As well as reviewing previous scientific research, researchers were given access to the WJA’s database of advisory alerts detailing adverse incidents from around the world. The WJA also assisted by contacting people who have experienced relevant injuries.

The research highlights how water jet injuries commonly have a very small entrance wound and no exit wound which can mask ‘extensive disruption’ caused to deeper tissues. The water jet can carry debris and bacteria associated with the cleaning process far into the body, increasing the risk of serious infection and medical complications. 01106-4

Such internal injuries represent a major medical trauma and need to be treated as such. However, to the untrained eye, this may not be immediately apparent. First responders, employers or the injured person may delay seeking specialist medical help. This can result in an injured person presenting themselves to their GP surgery or minor injuries unit, sometimes days later after complications have set in. Even then, research found there can be further delays to appropriate treatment.

Dr Sancho Rodriguez-Villar, intensive care consultant at Kings College Hospital, London, who led the research team, commented: “Without early and correct intervention, the evidence shows that the outcome for those injured is often catastrophic, including death, loss of limbs and long-term disability. We strongly advise all parties involved to observe the WJA’s newly updated guidelines for the management of high-pressure injection injuries.”

Key recommendations include:

• Operational water jetting teams should have access to trauma kits specifically to prevent blood loss.

• All water jet injuries should be treated as severe traumas, in a tertiary specialist hospital whenever possible.

• Evacuation by air ambulance to a trauma centre with surgical facilities must be considered in the early stages.

• Obtain early access to CT and MRI scans to assess internal injuries, and keep the patient under observation.

• Treat all wounds as if they are contaminated – kept open and surgically cleaned, in stages if necessary.

Following a year-long study, the research findings have been published in the European Journal of Trauma and Emergency Surgery. They include an algorithm detailing the optimum way to treat patients from the first response at the scene of an incident, through emergency care at hospital to ongoing treatment.

This algorithm is now a key element of the updated ‘Water Jetting Injury Management Guidelines’ in the WJA’s Codes of Practice – blue for high and ultra-high-pressure water jetting, red for water jetting in drains and sewers. Employers,


• Take wound swabs and tissue samples as soon as possible and send for microbiological and histological examination.

Thanks to the high health and safety standards observed by our members, supported by WJA water jetting training, injuries are not common. However, if they do occur, they can clearly cause serious trauma. That is why the WJA’s new injury management guidelines are so significant for all users of water jetting.

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