Preventing occupational chemical eye injuries: important lessons from poison information centres.

BACKGROUND

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.

OCCUPATIONAL HEALTH SURVEILLANCE

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.

CIRCUMSTANCES OF OCCUPATIONAL EYE EXPOSURES

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.

CHEMICAL EYE INJURIES

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.

ROOT CAUSES OF OCCUPATIONAL EYE EXPOSURES

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.

CONCLUSIONS

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.