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You are here: Home / Hazards / Systemic Safety Failures at the University of Hawaii

Systemic Safety Failures at the University of Hawaii

09/20/2016 By R.C. Costello

hazard-analysisMost people think of Hawaii and images of pineapples and luaus come to mind. The idea of a complex chemical laboratory is probably not one that would ever come to mind. Yet recently, in the middle of this island paradise, a postdoc student was seriously injured in an explosion that was completely preventable. This only goes to highlight the importance of maintaining a culture of safety to include hazard analysis in any setting where chemicals, equipment or other hazardous materials pose a risk.

Explosion and Initial Investigation

On March 16, 2016, the Honolulu fire department responded to a call at one of the labs on the Manoa campus of the University of Hawaii. They would eventually conclude that the explosion was caused by a faulty digital gauge that was used to check pressure levels on some of the tanks in the lab. These tanks contained hydrogen, oxygen and carbon dioxide — a dangerous combination with faulty equipment around.

The fire department concluded that the digital gauge was to blame. When the device was switched off, a small spark flew and ignited the gases, causing the explosion. This explosion happened after the exact incident occurred earlier, but was not reported. The warning signs were there and never properly investigated.

Further Investigation by the UC Center for Laboratory Safety

To the fire department, this was an open-and-shut case. There was no criminal intent. Faulty equipment caused an explosion and the case was closed.

The team at UCCLS decided to investigate further, looking for what the real root causes of such a dangerous and potentially deadly explosion were. Once their investigation concluded, they issued a report detailing their findings, including the systematic breakdown of even simple safety procedures.

The issue was not a faulty gauge, but one that was installed incorrectly in the first place. Since the metal tank was not grounded, the pressure gauge acted as a direct path to the ground for static electricity charges. When the static reached a peak level, the only place for it to discharge was directly into the gauge, which sparked and ignited the gases.

Warning Signs were Ignored

The explosion came as a surprise to many on the staff due to the fact that this was an experiment that had been running for a number of years. Unfortunately these are just the types of processes that end up causing issues.

The injured graduate student had indeed made reports about receiving electrical shocks. Proper care and treatment for chemical cylinders was not taught or enforced. There were no lab inspections in place to catch issues like the lack of grounding on the cylinders.

All of these factors, plus the lack of a safety-conscious culture, led to the explosion and the serious injury of a lab worker.

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Phone: 310-792-5870 Email: rcca@rccostello.com

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