Analysis of a clindamycin poisoning incident at a pharmaceutical factory

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Abstract of an analysis on a clindamycin poisoning incident at a pharmaceutical factory: This article reports on a clindamycin poisoning incident that occurred on June 3, 2005, at a pharmaceutical factory in Taizhou. By analyzing the causes of this accident, it is believed that it is necessary to strengthen occupational health supervision, enhance education and training on occupational health knowledge and relevant regulations, provide effective personal protective equipment, and ensure proper safety monitoring in order to prevent similar accidents from occurring. 　　On June 3, 2005, an ochratoxin poisoning incident occurred at a pharmaceutical factory in Taizhou. The analysis of the situation is reported as follows: 1. Incident overview: At 9:30 a.m. on June 3, 2005, Workshop 302 of the pharmaceutical factory began producing ochratoxin, and a small amount of dust was generated during the production process. A total of 4 people were working in that room, and the work came to an end around 11 a.m. Later, a female operator felt unwell at around 11:30 a.m., experiencing symptoms such as chills, shivering, nausea, dizziness, and discomfort in the throat. Later, pain in the chest was felt while breathing, the coughing worsened, and vomiting occurred after coughing; a total of about 7 episodes of vomiting took place. 　　Go to the hospital at 1:30 p.m. for treatment. Upon examination, the temperature was 37.5°C and the pulse rate was 80 beats per minute. Heart rate of 20 beats/min, rapid breathing; CT scan showed thickened and disordered lung markings. Symptoms were relieved after treatment with glucose, Houttuynia cordata injection, Zuo Ke injection, and Tylenol capsules. The other two workers felt dizzy, lightheaded, nauseous, had chest tightness, felt cold, and were weak when they went to work in the afternoon (b-3o); they went to the hospital at 3 p.m. and 4 p.m. One of them did not show any special symptoms and therefore did not seek medical attention. 　　After treatment with antibiotics, antitoxins, hormones, etc. at the hospital, the symptoms improved. All have been restored now. 　　2 On-site investigation: Workshop 302 of a certain pharmaceutical factory is located within the Waishadong factory complex. This workshop is primarily responsible for the production of solid dosage forms. Production of clindamycin began on the morning of June 3, 2005; 75 kg of clindamycin raw material was used in this process. The production process for clindamycin involves using the granular form of the raw material, along with pregelatinized starch, microcrystalline cellulose, particulate silica, and magnesium stearate, which are then combined after being crushed and screened. Grind and sieve in the morning, then mix again in the afternoon. The crushing and screening are carried out in the screening room located at Room 417, on the fourth floor of Workshop 302. This room is approximately 4 meters long, 2 meters wide, and 2.7 meters high. It contains a vortex oscillating screen and an air-cooled crusher. There is an air supply opening of 500 mm × 600 mm on the ceiling, while an air exhaust opening of 400 mm × 500 mm is located in the northeast corner of the room. Small amounts of brownish-yellow and white powder are scattered on the floor and on the crusher. It was reported that on the morning of June 3, the ventilation systems in the production room were turned on, but the dust removal fan inside the grinder was not activated, which caused dust to accumulate inside the room (investigations showed that these fans are always turned on during normal operation). Before entering the workshop, the 4 operators changed clothes twice, put on one-piece work uniforms and caps, and then wore regular gauze masks; however, one of them carried out the tasks without a mask. 　　3 Analysis of poisoning incidents Through investigation and on-site inspection. This poisoning occurred due to the small size of the workshop; 4 operators were carrying out powder-handling tasks in room 8111, some of them did not wear protective masks, and the dust removal fan inside the grinder was not turned on. Furthermore, investigations revealed that all 3 patients who sought medical treatment due to the illness had a history of penicillin allergy, aged 23, 26, and 42 respectively. Clotrimazole is an antibiotic and antifungal drug; the main side effect is that a small number of patients experience discomfort such as nausea and vomiting after taking it. The cause of this illness cannot be ruled out as adverse reactions resulting from workers inhaling excessive amounts of chrysostomium dust during operation. To prevent such poisoning incidents and protect the health of workers, the following recommendations are put forward: (1) Strengthen occupational health supervision to encourage enterprises to improve their occupational health management, with a particular focus on preventive occupational health supervision in order to control the occurrence of occupational poisoning at its source. (2) Strengthen publicity and vocational health training to improve employees’ awareness and ability for self-protection. (3) Actively carry out occupational health examinations and training for employees before they start working and while they are employed, establish a monitoring system for hazardous work environments, and improve safety production regulations and rules.