In the present study, we interviewed 310 patients acutely exposed to dangerous substances at work.

Patients were often exposed via multiple routes. Inhalation was the most common route of exposure (62%), followed by ocular (40%) and dermal contact (33%). A comparable exposure pattern was found in previous Poison Control Center (PCC) studies [7,8,9]. Similar to our study, other PCC studies also show that a variety of chemical compounds are involved in occupational incidents, with acids and alkalis ranking high in the number of exposures [9,10,11,12].

Most PCC studies describing acute occupational exposures, however, have a retrospective design, focusing on the characterization of the substances involved, specific populations at risk or medical aspects [2, 8,9,10,11,12,13,14,15]. In retrospective studies, information about the circumstances and causes of the exposure is often incomplete or lacking [2, 13]. In our prospective study, by interviewing patients involved in occupational accidents, we show that a Poisons Center is able to collect valuable data on the root causes of these accidents. A better understanding of the technical, organizational and personal factors contributing to accidents, offers opportunities for setting up preventive measures and better worker protection.

Occupational intoxications occur in various sectors of industries. In our study, most incidents occurred in the “Building and installation industry”, “Agriculture”, and “Health and welfare sector.” Incidents happened predominately in small-sized companies. In general, workers in smaller companies have a greater risk for accidents and injuries at the workplace [16, 17]. Temporary employees are generally at higher risk of an accident [16,17,18]. In this study, temporary workers were involved in 17% of the accidents.

Cleaning is a risky activity, as approximately one third of the accidents occurred during cleaning activities. The Swedish PCC also reported that a substantial part (24%) of occupational incidents involved cleaning agents or disinfectants [19].

When looking at the root causes of occupational intoxications, improper work instruction is an important factor that increases the risk for exposure to hazardous substances. In this study, 44% of the patients reported that there was no work instruction available. This was especially mentioned by patients working in business classes “Accommodation, provision of meal and drinks” and “Wholesale and retail.” Workers that are unaware of the potential hazards of chemicals in their work environment, are more vulnerable to exposure and injury [16, 17]. Therefore, it is important to continuously educate workers on the hazards of the chemicals at work and to provide clear work instructions.

Occupational exposure is not always the fault of the patient him or herself as in 31% of the incidents a patient was exposed to a hazardous substance because a colleague made a mistake. This stresses the importance of vigilance among all employees in a work environment where dangerous substances are used.

Technical factors can cause occupational exposure to dangerous substances. In this study, damaged packaging (especially mentioned by patients working in business class “Transport and storage”) and defective apparatus often caused occupational exposure. These data illustrate that proper maintenance of machinery is important. Instructing employees to careful handle packaging and attention to the design of packages can lead to a further reduction in the number of occupational incidents [20].

Personal factors also play an important role in occupational exposure to hazardous substances. Half of all patients in this study reported that inaccuracy, time pressure and/or fatigue played an important role in the incident. Fatigue increases the risk for injuries at work [17]. Approximately one in three patients did not wear the obligatory safety glasses. In some cases, patients thought a face shield or wearing regular glasses would offer appropriate protection. This shows that merely providing PPE, especially protective glasses, is not enough. In order to decrease the risk of exposure, employers should not only provide but also instruct their employees how and when to use PPE [19, 20]. It should be emphasized that the wearing of PPE is also important during preparatory, maintenance or repair and cleaning activities.

The majority of the patients in our study only reported mild health effects and recovered quickly. This can possibly be explained by the fact that decontamination as a first-aid measure was often carried out promptly after the exposure. Data from other PCC studies also show that the majority of occupational incidents had mild outcomes [7, 12,13,14]. One in five patients reported absence from work, mostly during a short period. 80% resumed their normal activities within 5 days. However, it is rather common practice in many companies that mildly affected workers temporarily perform other tasks within the company, until they have fully recovered from their exposure. In general, occupational illness and injury and subsequent absence from work is underreported [16, 17, 21, 22].

In most countries there is a legal obligation to report incidents at work with fatal outcome, hospitalization or permanent injury [16, 17, 23]. This results in robust monitoring of severe, work-related exposures to hazardous substances. Minor injuries requiring first-aid only, are often not reported to governmental authorities. However, small and seemingly insignificant incidents can precede major incidents and in itself offer a chance to learn from these. Because of the easy accessibility the DPIC receives a large number of calls for rather minor health effects from (especially) general practitioners. These incidents are not accounted for in the national labor injury statistics and are therefore considered supplementary to national statistics on work-related accidents. The large number of calls for rather minor health effects from physicians to a Poisons Center reflects the fact that medical professionals, especially general practitioners, have little experience with acute exposure to dangerous substances at work.

PCC data have several limitations that may bias the results. First, data is based on voluntary reports to the DPIC, which may lead to an underestimation of the true incidence of occupational intoxications in the Netherlands. Another potential source of bias is that specific workers might be underrepresented in the study population. For example, workers employed at companies with less progressive occupational protocols may have fear of retaliation or being fired, or temporary workers could be less motivated to participate. A language barrier did not seem to be a major reason for non-participating in our study, as it was only mentioned a few times before the start of the interview. It was remarkable how many patients reported personal factors as an important cause of the incident. Patients may be inclined to falsely attribute the etiology of the accident to certain factors. From our study it remains difficult to judge whether factors such as time pressure or fatigue are solely personal factors or (in part) related to organizational factors. Better defining this would require more in-depth research at a company’s overall organization.

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