Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht University, the Netherlands.
Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands.
Clin Toxicol (Phila). 2023 Aug;61(8):573-576. doi: 10.1080/15563650.2023.2250068. Epub 2023 Sep 4.
Occupational exposure to hazardous substances is a major public health problem. In the workplace, eye exposures are common and can be a major cause of morbidity and disability. This commentary discusses the role of poison information centres in providing valuable information on the circumstances and causes of these incidents.
As many eye exposures are easily preventable, there is a need to establish better safety practices in the workplace. Currently, both governments and labour organizations primarily employ injury statistics for the purpose of occupational health surveillance. Identifying risk factors associated with acute exposures in the workplace requires a comprehensive approach using a variety of information resources. Using information from poison information centres can provide invaluable insight into the specifics of the exposure, including the route(s) of exposure, the substances involved and the cause of the exposure.
Exposure to hazardous substances can occur at various time points during work. A prospective study performed by the Dutch Poisons Information Centre showed that cleaning is a high-risk activity for occupational eye exposure. Patients were often exposed to chemical mixtures that frequently contained alkalis or acids.
Symptoms following eye contact with chemicals can vary greatly depending on factors such as the type and concentration of the substance(s) involved, the duration of exposure and the time and duration of irrigation (first-aid measure). Eye contact will usually cause irritation, but in more severe cases, chemical burns will result. Recent studies demonstrate that occupational eye exposures often result in only relatively mild symptoms, such as pain, redness, lacrimation or temporary loss of vision. More severe symptoms, such as corneal abrasion, were reported rarely, which may be explained by prompt eye irrigation.
To control risks to workers, a hierarchy of prevention and control measures has been established, which employers must take. If elimination or substitution of the dangerous substance is not possible, the exposure can be prevented or reduced by taking organizational (e.g., providing work instructions), technical (e.g., ventilation) and personal (e.g., wearing personal protective equipment) measures. The study performed by the Dutch Poisons Information Centre showed that organizational factors (such as lack of work instructions) and personal factors (such as time pressure and fatigue, and not (adequately) using personal protective equipment), were the main causes of occupational eye exposure.
Poison information centres provide valuable information that can be used to develop prevention strategies to reduce the number of acute occupational exposures in the future. A multidisciplinary approach is essential to ensure that these preventive measures are actually applied in practice. Therefore, all organizations involved (including governments, labour organizations, medical professionals, occupational physicians, occupational hygienists, safety experts and poison information centres) must work closely together.
职业接触有害物是一个主要的公共卫生问题。在工作场所，眼部暴露很常见，并且可能是导致发病和残疾的主要原因。本篇述评讨论了中毒信息中心在提供这些事件的情况和原因方面的宝贵信息所扮演的角色。
由于许多眼部暴露很容易预防，因此需要在工作场所建立更好的安全实践。目前，政府和劳工组织主要利用伤害统计数据进行职业健康监测。要确定与工作场所急性暴露相关的风险因素，需要采用各种信息资源的综合方法。利用中毒信息中心的信息，可以深入了解暴露的具体情况，包括暴露途径、涉及的物质以及暴露原因。
在工作过程中的不同时间点，都可能会接触到有害物质。荷兰中毒信息中心进行的一项前瞻性研究表明，清洁是职业性眼部暴露的高风险活动。患者经常接触到化学混合物，这些混合物中经常含有碱或酸。
眼部接触化学物质后，症状会因涉及的物质类型和浓度、暴露时间以及冲洗（急救措施）的时间和持续时间等因素而有很大差异。眼部接触通常会引起刺激，但在更严重的情况下，会导致化学灼伤。最近的研究表明，职业性眼部暴露通常只会导致相对较轻的症状，如疼痛、发红、流泪或暂时视力丧失。更严重的症状，如角膜擦伤，很少见，这可能是由于及时冲洗眼睛所致。
为了控制工人的风险，雇主必须采取预防和控制措施的分层措施。如果无法消除或替代危险物质，则可以通过采取组织（例如提供工作说明）、技术（例如通风）和个人（例如佩戴个人防护设备）措施来预防或减少暴露。荷兰中毒信息中心的研究表明，组织因素（例如缺乏工作说明）和个人因素（例如时间压力和疲劳，以及没有（充分）使用个人防护设备）是职业性眼部暴露的主要原因。
中毒信息中心提供了有价值的信息，可用于制定预防策略，以减少未来急性职业暴露的数量。多学科方法对于确保这些预防措施在实践中得到实际应用至关重要。因此，所有相关组织（包括政府、劳工组织、医疗专业人员、职业医生、职业卫生学家、安全专家和中毒信息中心）都必须密切合作。
