環保清潔隊員手部皮膚炎及足部黴菌疾病調查

Abstract

背景：在1994年臺灣職業性皮膚症狀研究發現從事環保清潔工作之勞工患有職業性上肢皮膚不適的比例最高；我們的清潔隊的先趨研究也發現環保清潔隊員似乎有較高比例罹患足部黴菌疾病。若能了解環保清潔隊員手部皮膚炎及足部黴菌疾病的盛行率與相關危險因子並加以預防，將有助於職場衛生。 目的：了解環保清潔隊員手部皮膚炎、職業相關的手部症狀、以及足部黴菌疾病的盛行情況與相關危險因子。 方法：本研究為橫斷式研究。收案對象為現職男性清潔隊員，其工作包括掃街、清溝、洗垃圾箱、處理一般垃圾、資源回收、廚餘回收、以及清小廣告。本研究使用結構性問卷了解清潔隊員相關暴露、過敏情形以及過去一年的手部症狀，並由作者確定皮膚疾病診斷。本研究於2009年6月至11月間進行，由某環保單位的五區域隊員中隨機抽樣，共邀請346位參加者，最終共有274位有效樣本。並以邏輯斯迴歸（Logistic regression）分析各因子與疾病的關聯。 結果與討論：清潔隊員在過去一年中曾有工作相關的手部症狀與被診斷患有手部皮膚炎的盛行情況分別為19.0%與22.6%。工作中接觸清潔劑超過30分鐘會增加罹患皮膚炎的危險（aOR [95%CI] = 2.66 [1.11-6.20]），接觸水超過兩個小時也可能增加罹患皮膚炎的危險，但僅達到邊際顯著（aOR [95%CI] = 2.03 [0.98-4.22]）。使用橡膠（aOR [95%CI] = 5.94 [1.04-33.90]）及乳膠手套（aOR [95%CI] = 10.29 [1.35 -78.25]）的隊員較容易發生手部皮膚炎。工作中經常發生手套滲漏也會增加患有手部不適（aOR [95%CI] = 2.32 [1.13-4.75]）。而從事清溝工作為主的隊員亦會增加患有手部不適（aOR [95%CI] = 2.98 [1.03-8.62]）。 在足部部分，清潔隊員足癬與甲癬的盛行率分別為47.8%與31.0%。年齡較長是罹患黴菌感染之重要危險因子，尤其年齡在50歲以上的清潔隊員，其罹患足癬（OR [95%CI] = 2.89 [1.05-8.74] )與甲癬（OR [95%CI] = 3.80 [1.18-16.96]）的危險性皆較21至30歲的清潔隊員為高。身體質量指數（body mass index，BMI）超過25也會增加罹患足癬的機會（aOR [95%CI] = 2.34 [1.39-4.00]）；穿運動鞋的時間越長，會增加罹患甲癬的危險（aOR [95%CI] = 3.59 [1.17-11.26]）。 結論：清潔隊員的工作相關的手部不適以及皮膚炎盛行率各約二成。本研究發現工作中接觸清潔劑超過30分鐘、接觸水超過2小時、經常發生手套滲漏、使用乳膠或橡膠手套、以及清溝工作為主的隊員較容易患有手部皮膚問題。約五成清潔隊員患有足部黴菌疾病，罹病危險性隨年齡增加，BMI超過25kg/m2也會增加足癬的風險，減重可能有助於減少足癬的盛行率。

Background: A nationwide survey in Taiwan in 1994 showed a high prevalence of work-related upper extremity symptoms in sanitary and pollution control personnel. In addition, a high prevalence of foot fungal infection was suggested in our pilot study for environmental sanitation workers. Identifying risk factors may provide us with prevention methods and improve workplace health. Objectives: To determine the prevalence of hand dermatitis, work-related hand symptoms and foot fungal diseases and to identify risk factors. Methods: The cross-sectional study recruited current environmental sanitation workers engaged in a number of tasks, which were street-cleaning, gutter-cleaning, garbage can cleaning, disposal of general waste, resource recycling, food waste recycling, and removal of street ads. The study involved a structured questionnaire and a skin examination. The questionnaire consisted of personal exposures, allergic conditions, and hand skin symptoms in the past 12 months. The skin examination was conducted by the author. The study was conducted from June 2009 to November 2009. A total of 346 workers were randomly selected and the data of 274 eligible participants were analyzed. The association of risk factors and diseases were presented as an odds ratio utilizing logistic regression analysis. Results and Discussion: The prevalence of work-related hand symptoms in the past 12 months current hand dermatitis were 19.0% and 22.6%, respectively. Contact to detergent over 0.5 hour significantly increased the risk for hand dermatitis (aOR [95%CI] = 2.66 [1.11-6.20]). Contact with water for more than 2 hours at work showed a borderline increase of risk (aOR [95%CI] = 2.03 [0.98-4.22]). Using rubber (aOR [95%CI] = 5.94 [1.04-33.90]) or latex gloves (aOR [95%CI] = 10.29 [1.35 -78.25]) at work increased the risk of hand dermatitis. Frequent leakage of gloves at work predisposed to work-related hand symptoms (aOR [95%CI] = 2.32 [1.13-4.75]). Workers mainly involved in gutter cleaning also had a higher risk. (aOR [95%CI] = 2.98 [1.03-8.62]) The prevalence of tinea pedis and toenail onychomycosis were 47.8% and 31.0%, respectively. Age was the most significant risk factor, especially for workers over 50 years old, with odds ratios 2.89 (95%CI =1.05-8.74) for tinea pedis and 3.80 (95%CI =1.18-16.96) for onychomycosis. Body mass index (BMI) over 25 kg/m2 increased the risk for tinea pedis (aOR [95%CI] = 2.34 [1.39-4.00]). Longer duration of wearing sneakers predisposed to onychomycosis (aOR [95%CI] = 3.59 [1.17-11.26]). Conclusion: Approximately 20% of environmental sanitation workers experienced work-related hand symptoms and hand dermatitis. The study showed the risk factors were contact to detergent and water, wearing rubber or latex gloves, and frequent experience of leakage while wearing gloves. Gutter cleaning may be a risk task. About 50% workers were diagnosed as having foot fungal infection. The risk increased with age. BMI over 25 kg/m2 predisposed to tinea pedis, suggesting weight reduction may lower prevalence.