Dr Sarah Hall, Jo Morrissey
ARU research has raised awareness of the flammability of emollients built up on fabrics. New safety advice, training, awareness-raising and prescription changes are now in place.
If you use emollients on your skin, they can dry and build up on fabrics like clothing and bedding, increasing their flammability. Over the last 20 years, more than 50 deaths in the UK have been linked with the victims’ use of an emollient; this is a considerable proportion of fatalities due to clothing/bedding fires. Unsuitable safety advice was given on such products, and their contribution to fatal fires was underreported.
This is notable when considering GPs in England prescribed emollients over 10.5 million times in 2018. 76% of the over 70s have at least one skin condition; there is a high use of emollients among this age group.
Joanne is currently a Visiting Associate Professor, having been a full time member of staff until 2021. Joanne was the Director of Learning, Teaching and Assessment for the Faculty of Science and Engineering and taught on the Crime and Investigative Studies and Forensic Science courses.Find out more about Joanne Explore ARU researchers' original work via our open access repository, ARRO
Dr Hall found a new method for collecting ignitable liquid residues from fire scenes. She collaborated with Essex Fire and Rescue Services (FRSs) on the flammability of emollients after a fatality.
The initial research showed increases in flame height with fabrics impregnated with emollients. Further tests revealed large reductions in ignition time with fabrics impregnated with dried-on paraffin-based products.
Additionally, indicating the likelihood of severe skin burns, it was shown that some impregnated fabrics burn longer next to the skin. It demonstrated that someone’s chance to react quickly enough if clothing or bedding accidentally catches fire is reduced when emollients are present, especially for the elderly or immobile.
In 2018, Dr Hall and Joanne Morrissey started running consultations on emollient safety with stakeholders including the Medicine and Healthcare products Regulation Agency (MHRA), West Yorkshire FRS and London Fire Brigade. Further research investigating paraffin-free skincare products showed similar burn behaviour as with the paraffin-based variety.
These findings are important, as previous MHRA advice only related to products that contain more than 50% paraffin. Their research showed that fabrics with characteristic flame-retardant properties also ignited quicker when impregnated and demonstrated the serious fire risk caused by emollient-impregnated bed sheets, gowns or nightwear, often used in care homes and hospitals.
Research carried out with West Yorkshire FRS investigated how successfully the MHRA’s new safety advice on emollients had been communicated internally and publicly: 63% of FRSs and 72% of local health boards had no safety advice within their website or formularies. The same was true of 32% of Clinical Commissioning Groups (CCGs). Of those that did have such advice, very few were up to date.
Further exploration of fatalities in dwellings revealed that clothing and bedding are a contributory factor in the UK. It suggests underreporting and reveals that international awareness is limited.
The collaboration with West Yorkshire and Essex FRSs and the London Fire Brigade won the Collaboration of the Year award at the Excellence in Fire and Emergency Awards in December 2019.
The research primarily benefited the following groups/organisations:
The MHRA issued a drug safety update in December 2018 highlighting the risks presented by low-paraffin and paraffin-free products and dried-on residues on clothing. It advised healthcare professionals to warn patients using emollients not to smoke, not to go near naked flames and to be aware of the risk of easy ignition. The MHRA’s July 2020 communication strategy for professional bodies also included the research findings.
The MHRA updated regulations and licences for manufacturers to include flammability warnings on products - by the end of 2020 178 licenses had been updated or were pending.
ScriptSwitch (the prescribing software used widely by the NHS) was updated by 17 NHS CCGs (as of May 2019) to include a flammability warning on all skincare products.
The British National Formulary (BNF) was updated to warn against the risk of severe burns with paraffin-based and paraffin-free emollients.
A campaign on safer use of emollients was launched in October 2019 with Cambridgeshire and Peterborough CCG and Cambridgeshire FRSs. Campaign material was sent to over 500 local pharmacies, dispensing practices, GP practices, acute trusts, hospices and care homes. This included:
The campaign was effective, feedback demonstrated.
'The bags were an excellent prompt. Nearly all patients asked why they had a special bag, which facilitated the conversation.'
'It allowed us to effectively target those patients for whom this campaign was intended.'
Dr Hall and Joanne Morrissey gave talks and presentations to West Essex CCG, NHS Home Oxygen Services (HOS) and patient safety groups. Attendees changed their advice to emollient users and the HOS changed its advice to practitioners and patients, warning against touching oxygen systems with hands contaminated with creams, and the risks of wearing of clothes impregnated with dried residues of emollients.
The National Fire Chiefs’ Council (NFCC), the professional voice and a major resource of all 53 of the UK’s FRSs, released a statement on the importance of being aware of the hazards posed by paraffin-free emollients. The NFCC Emollients Lead, said:
'We are asking people who prescribe, dispense or apply these products to be aware that switching to a lower or paraffin-free emollient will not reduce the fire risk. Washing fabrics will reduce the risk but may not totally remove it.'
Research results are now incorporated into training packages in the FRSs.
Prometheus Forensic Services, an independent fire investigation company and training provider, asks police forces that have fire-related work to note the use of emollients in any of the cases.
Analysis of fabrics for emollients has been used in at least one fire investigator’s report to the coroner.
We have mapped our REF 2021 impact case studies against the United Nations' Sustainable Development Goals (SDGs).
The 17 SDGs, adopted by all UN Member States in 2015, are an urgent call for action. They recognise that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests.
This case study is mapped to SDG 12: Ensure sustainable consumption and production patterns, target 12.4.
Dr Sarah Hall has now left ARU but, along with Jo Morrissey, is happy to respond to enquiries about this research project. Email [email protected].