台灣職場眼球外傷個案交叉研究

Abstract

工作為導致眼球外傷的重要原因之一，職場眼球外傷對勞工身心、家庭與社會造成的影響並不亞於其他職業傷害；經濟上的損失更是難以估計。本研究目的為與全台各眼科教學醫院合作，收集職場眼球外傷個案的臨床資料，並進行電話問卷訪問，以建立台灣本土職場眼球外傷個案資料庫，分析職場眼球外傷的成因及嚴重度；並利用個案交叉研究法（case-crossover study）的matched-pair interval approach及usual frequency approach探討造成職場眼球外傷的暫時性風險因子。本研究結果收集民國92-95年全台八家眼科教學醫院共283位職場眼球外傷個案，大部分以男性為主（91.5%），平均年齡為40.2歲；社經地位偏低，教育程度47.7%為國中小學以下，81.6%的受傷個案年收入小於新台幣50萬元。受傷個案從事職業多為工廠製造業(34.6%)、營造建築業(24.7%)、及農牧養殖業(15.2%)，公司規模以自營雇主及10人以下的中小型企業居多（66.7%）；85.9%的受傷個案為基層員工，受傷比例隨著工作年資增加，有76.3%的受傷個案工作年資超過5年。受傷形態方面，常見的受傷機轉為焊接（30.4%）、鑽孔/裁切（13.4%）、化學液體噴出（11.7%）、及鎚擊（10.2%）；常見的危害物有強光/ 輻射線（33.2%）、機器噴射的碎片（20.9%）、尖銳物（15.2%）、及及化學溶液（12.4%）導致受傷。造成的傷害以閉鎖性的眼球外傷（68.6%）居多，其中最多的為輻射性傷害（33.2%）及化學性灼傷（14.1%）；而開放性眼球外傷佔了31.4%。受傷就診時測量視力小於3/60的有55.2%，其中64.3%的病患在緊急處置後可以出院門診追蹤。 在個案交叉研究中以match-paired interval approach探討暫時性風險因子暴露對質場球外傷的影響發現工作時配戴護目鏡可以降低64%的相對風險（OR=0.36, 95% CI=0.17-0.74）；而工作時進行不常做的工作任務（OR=57.0, 95% CI=14.1-230.7）、操作不常用的機具設備（OR=48.5, 95% CI=12.0-196.7）、分心（OR=24.0, 95% CI=3.2-177.4）、趕工（OR=13.0, 95% CI=3.1-54.8）、疲倦（OR=10.0, 95% CI=1.3-78.1）、及處於特殊作業環境（OR=4.3, 95% CI=1.4-12.6）等暴露因子則會增加眼球外傷的相對風險。但另外以usual frequency approach分析發現護目鏡沒有明顯的保護效果（IRRM-H=1.21, 95% CI=0.79-1.86）。進一步針對不同職業別、工作年資、及危害物分層分析發現護目鏡對農牧養殖業（IRRM-H=0.06, 95% CI=0.01-0.96）及工作年資小於5年的勞工（IRRM-H=0.19, 95% CI=0.13-0.28）有明顯的保護作用，此外針對機器噴射出的碎片也有明顯的保護作用（IRRM-H=0.34, 95% CI=0.14-0.83）。本研究證實護目鏡雖然具有保護效果，但勞工的工作態度及行為，以及工作的環境更是影響職場眼球外傷的重要因素。未來可根據此研究結果，針對高風險的勞工族群，依其工作特性及知識教育程度設計適合的職場眼球外傷安全衛生教育訓練課程；另外一方面應鼓勵公司管理階層提升公司的安全文化，提供員工充足且適當的防護設備及進行工程控制的改善措施，以有效降低勞工職場眼球外傷的發生率。

Work-related eye injuries are important etiologies of blindness, and account for a large proportion of occupational injuries. Work-related eye injuries not only hurt workers themselves and their family, but also cause huge loss of productive power and social cost. The purpose of this study was to describe the epidemiology of work-related eye injuries in Taiwan. We also conducted the case-crossover study with telephone-interviewed structured questionnaires to explore the transient preventable and risk factors of work-related eye injuries. A total of 283 cases reported from eight ophthalmologic teaching hospitals in Taiwan ranging from 2003 to 2006 were completely interviewed. The results showed that most of those injured were male (91.5%) and the average age was 40.2 years. 47.7% whose education was below junior high school and 81.6% of cases had an annual income less than NT$ 500,000. The most liable to suffer injury was workers engaged in traditional industries (34.6%), construction (24.7%), and agriculture (15.2%). Among these cases, 66.7% were from small enterprises with workers number below 10 or self-employed workers, and 85.9% were menial workers. 76.3% of those injured are senior workers who had worked more than 5 years. Most common mechanisms of work-related eye injuries were welding (30.4%), drilling/cutting (13.4%), chemicals splash (11.7%), and hammering (10.2%); and injuries were frequently caused by welder’s flash /radiation (33.2%), projectile/blasting fragments (20.9%), sharp objects (15.2%), and chemical solvents (12.4%). 68.6% of subjects were closed eye globe injuries, among which radiation (33.2%) and chemical burn (14.1%) were most common injured types. 31.4% were open eye globe injuries. 55.2% of patients had a visual acuity of 3/60 or less at the time of the injury; it was suggested that 64.3% of patients have OPD follow-up after primary treatment. In case-crossover study, matched-pair interval study was first used and the results showed that wearing eye protective devices (EPD) could reduce 64% relative risk of work-related eye injuries (OR=0.36, 95% CI=0.17-0.74). On the other hand, the relative risk of work-related eye injuries increased when performing unfamiliar tasks (OR=57.0, 95% CI=14.1-230.7), operating unusual tools or equipments (OR=24.0, 95% CI=3.2-177.4), distracted (OR=24.0, 95% CI=3.2-177.4), rushing (OR=13.0, 95% CI=3.1-54.8), fatigued (OR=10.0, 95% CI=1.3-78.1), or working under special environments (OR=4.3, 95% CI=1.4-12.6). However, there was no significantly protective effect of wearing EPD while analyzed with usual frequency approach ( IRRM-H=1.21, 95% CI=0.79-1.86). The data was further stratified with occupational categories, job experiences, and hazard materials; and it was found that EPD did have protective effect to agriculture workers (IRRM-H=0.06, 95% CI=0.01-0.96), junior workers (IRRM-H=0.19, 95% CI=0.13-0.28), and workers threatened by projectile objects (IRRM-H=0.34, 95% CI=0.14-0.83). The results of this study indicated the protective effect of EPD was limited; worker’s attitude and practice, and working environments were more determining risk factors to work-related eye injuries. Accordingly, strategies including designing appropriate health education and safety training programs, strengthening safety culture, providing proper protective devices, and engineering control must to be introduced to both high-risk workers and administrators to reduce the incidence of work-related eye injuries in Taiwan.