Explosion and fire at a university laboratory

The incident occurred at a chemical laboratory of a university. Six students were conducting experiments on producing nitrification carriers for waste leaching when an explosion followed by a fire accident occurred in the laboratory.
The cause of the explosion was the accidental production of hydrogen when mixing magnesium powder and phosphoric acid together in a mixer. The hydrogen gas generated in the hopper was ignited by the sparks generated by the metal friction at the rotating shaft of the mixer, which then triggered the explosion of magnesium powder, which ignited the rest of the magnesium fine powder stored in the lab (66 kg) and other combustible materials.
Three students were killed. The official investigation concluded several violation of regulations were occurring during university laboratories activities, such as illegal purchase and storage of hazardous chemicals, inadequate safety management. Based on these findings, a legal procedure was started against the project responsible and the laboratory manager. Disciplinary sanctions were decided on university managers covering higher management positions.

The INITIATING CAUSE was the accidental production of hydrogen during the execution of a experiment.

The ROOT CAUSE is a sever lack of safety culture, proper risk assessment and preventive and mitigating safety measures throughout the university organisation.

mixer, hopper

The sources do not say if the experiment was a one-off or part of a series already executed before, in which case it would be important to know why they did not cause the incident under different conditions.

The entire laboratory was destroyed.
The source report only 3 fatlities, nevertheless it is plausible to ssume that the other 3 students participating to the experiments were injured.

This was the first university laboratory incident which triggered an official investigation made also publicly available. The incident contributed to raise general governmental and public authorities’ awareness to the need of a better regulated and enforced laboratory safety.
The investigation and the following study (see references) identified several components which created hazardous condition for the incident to occur, such as (i) illegal purchase of hazardous chemicals; (ii) improper emergency handling by personnel, maintenance and repair of equipment not performed according to schedule; (iii) Shortcoming in handling of hazards from high temperatures and pressures; (iv) inadequate risk assessment and management of changes; (v) failure to follow operating instructions and ineffective operating procedures.
1. Workers’ behaviour: personnel was not aware of legal requirements and were ignoring the need for safety measures. They were not attending effective safety training and the manager failed to enforce regulations and raise awareness with effective actions.
2. Inadequate Safety Management System
3. Lack of safety culture throughout the university structure, so that the safety dimension was not integrated into the teaching structure.
An interesting aspect of the analysis, among several others, is the realisation that university, because of their peculiar activities structure, require tailored risk assessment methodologies: for example, university laboratories are characterised by a turnover rate much higher than other professional organisations, and by a complex structure of personnel education.
Bai at al. proposed the following main action lines to be adopted through the high education system of the Country:
(1) Improve leadership's commitment to safety and strengthen safety culture
(2) Develop differentiated laboratory risk factor assessment methods
(3) Strengthen the procurement management of laboratory supplies
(4) Improve the quality of laboratory safety training
(5) Establish a shared dataset of accidents in academic laboratories