背景：高科技產業產品之製造環境所需條件控制愈趨嚴格，例如溫度與濕度條件，以達到產品順利製造及提高良率。而人員進出此一控制作業環境更須遵循環境要求，需著全身無塵衣，此一不便限制可能導致衛生習慣之改變而帶來不良健康影響，例如女性員工常見之泌尿道感染。部份極端低溼度物理環境條件亦可能引致身體生理參數之變化。因此本研究擬針對此一高科技產業之控制作業環境相關之健康影響做一探討。
材料與方法：本研究採橫斷式研究及縱貫式研究設計，分別2001年及2003年於台南科學園區，配合公司進行年度健康檢查進行。分別以如下五項子題進行：(1) 中等溼度作業無塵室環境勞工之皮膚、眼睛及鼻喉黏膜乾燥症狀之盛行率研究。(2) TFT-LCD光電廠無塵室女性點燈作業人員淚液分泌不足之因素探討。(3) 電子業懷孕女性無塵室員工泌尿道感染盛行率調查及相關危險因子分析。(4) 以密集衛教介入方式改善無塵室女性作業員泌尿道感染。(5) 以尿比重為指標評估極低濕度作業人員之脫水危害。其中(1)-(4)研究對象為某光電廠無塵室工作者，無塵室作業之其常態作業環境溫度為22-25℃及相對濕度為50±5%，非無塵室作業之常態作業環境為溫度22-28℃、相對濕度65±5%。(5)研究對象為某鋰電池工廠乾燥室作業環境。分別以自填式問卷調查、身體理學檢查、尿液常規檢查及視力相關檢查等內容進行。而研究(4)則以追蹤衛教介入後二年之衛生行為與泌尿道感染之變化。
結果：於研究(1)發現無塵室暴露員工發現有皮膚脫皮、脫屑及癢，眼睛乾澀、鼻子與喉嚨乾之盛行率明顯較非無塵室員工高。無塵室員工皮膚乾燥症狀之好發位置分佈以手掌(59.8%)、手臂(14.9%)及臉部(14.2%)居多。而無塵室工作(OR=1.38)、家族過敏史(OR=1.75)及使用保溼乳液(OR=1.64)為獨立危險因子，年齡28至30歲組則為獨立保護因子 (OR=0.73) 。而無塵室工作亦為眼球乾燥症狀(AOR=1.30)與鼻喉乾燥症狀(AOR=1.70)之獨立危險因子。於研究(2)發現319位無塵室點燈作業人員眼睛不適症狀群的盛行率為69.3％，其中盛行率最高者為眼睛乾澀（43.3％）。而Schirmer氏淚液基礎分泌測試結果顯示受試者淚液分泌不足之異常率為40.1％（128人）。迴歸分析的結果顯示作業年資越長者越容易有自覺眼睛不適的情形，且工作時有配戴隱形眼鏡習慣者，其發生淚液分泌不足之危險性為沒有配戴隱形眼鏡者的1.73倍；經過一年的工作後，淚液分泌不足的盛行率顯著上升(32.8% vs. 40.9%)。研究(3)收集2062名女受檢者，其中懷孕女性員工有118名，未懷孕的女性員工有1944名，總共有34名符合有症狀UTI診斷條件，其中7名為懷孕員工，沒有懷孕的女性員工為27名；懷孕員工有症狀UTI之盛行率高於無懷孕女性員工(7.6% vs. 1.6%)。懷孕員工發生有症狀UTI的機率是未懷孕員工的6.33倍，而發生無症狀UTI之機率是未懷孕員工的2.13倍。每一工作班別排尿3次及以上者則為無症狀UTI之保護因子(OR=0.40)，以及有症狀UTI之具邊際意義之保護因子(OR=0.24)。研究(4)發現同一公司接受2003年9月年度健檢之女性員工，有無塵室女性員工1414名及非無塵室女性員工252名。無塵室與非無塵室女性員工罹患有症狀UTI均為0.8%, 二者並無統計上差異。選取2次健檢同時在職女性員工366名前後比較，發現每一班別喝水3次以上、每一班別上廁所3次以上比率均有增加，且有症狀UTI盛行率有明顯下降(由9.8% 降至 1.6%) 。於研究(5)發現暴露於極端低溼度作業環境人員與非暴露組人員之尿比重異常盛行率達統計上顯著差異(24.0% vs. 4.1%)；經多變項邏輯式迴歸分析發現暴露組人員比非暴露組人員有12.6倍的機率會發生尿比重異常濃縮(USG ≧ 1.030)的現象。
結論：現代高科技產業之作業環境限制環境物理條件也間接限制了作業人員之人因條件，雖然無塵室環境溼度並非極低，但對於長期生活於高濕度環境之工作者而言，此一相對低濕度環境亦可能導致眼球、鼻喉黏膜之乾燥症狀發生、眼球淚液分泌異常率較高以及較易有泌尿道感染情形。但由本研究結果發現工作中勿配戴隱形眼鏡可避免眼球乾燥，以及多喝水經常排尿則可減少泌尿道感染。因此只要能了解此作業環境所帶來之不良健康效應，這些問題是可以預防的。

Background: In modern industries, many products are manufactured in environments under strict control to ensure the quality. In these environments, the physical conditions controlled by engineering measures may include humidity, dust, temperature, illumination, and airflow. A higher prevalence of urinary tract infection (UTI) was observed among clean room workers. Under ultra-low humidity working environment, a worker may have concentrated urine or dehydrated status due to excessive body water loss (epidermal evaporation). We use urine specific gravity (USG) as a biomarker to evaluate the hydration status of workers in such a controlled environment.
Materials & Methods: We recruited workers working in an industrial park in Tainan, Taiwan who received the annual routine health examination at the clinic in the park in Sept. 2001 and Sept. 2003. We conducted the following five studies: (1) Higher prevalence of dry symptoms in skin, eyes, nose and throat among workers in clean rooms with moderate humidity. (2) Tear Secretion Dysfunction among Woman Workers Engaged in Light-on Tests in the TFT-LCD Industry. (3) Prevalence of urinary tract infections and associated factors among pregnant workers in the electronics industry. (4) Reducing Urinary Tract Infections through intensive health education among Female Clean Room Workers. (5) Using Urine Specific Gravity to Evaluate the Hydration Status of Workers Working in Ultra-Low Humidity Environment.
Results: In study (1), among the 3,154 participants without past history of skin diseases, clean room workers had higher prevalence of dry eye symptoms , dry nose and throat symptoms , and dry skin symptoms (itching, scaling, and fissuring) in comparison with other workers. In clean room workers, dry skin symptoms affected relatively more frequently the palm but less frequently the face. Multiple logistic regressions showed that working in clean rooms (OR=1.38), 28 to 30 years of age (OR=0.73), family history of atopic diseases (OR=1.75), and skin moisturizers use (OR=1.64) were independent predictors of skin symptoms. In study (2), the 319 qualified light-on test workers showed that eye dryness was the most prevalent (prevalence = 43.3 %) within the 11 ophthalmic symptoms. In addition, the prevalence of tear secretion dysfunction in at least one eye was 40.1% (128 cases), and contact lens users had an odds ratio of 1.73 in comparison with non-contact lens users. Comparing the Schirmer’s test results of those who also participated in the screening in the previous year, we found the prevalence of tear secretion dysfunction increased with statistically significant (32% vs. 40.9%, p = 0.02 for McNemar’s test). In study (3), a total of 2,062 workers, including 118 pregnant and 1,944 non-pregnant women, participated in the study. Pregnancy was a significant risk factor for both symptomatic (OR= 6.33) and asymptomatic (OR= 2.13) UTIs. Urine voiding three or more times during a shift was a significant protective factor for asymptomatic UTI (OR= 0.40) and a protective factor for symptomatic UTI with marginal statistical significance (OR= 0.24). In study (4), for 1414 clean room workers and 252 non-clean room workers, agreed to participate, we found similar prevalence (both 0.8%) of symptomatic UTIs (patients with clinical symptoms such as voiding frequency, urgency, and burning sensation during voiding) in clean room and non-clean room workers. In the 366 participants who also participated in the previous study, we found a significant decrease in the prevalence of UTI (from 9.8% to 1.6%) and significant increases in the prevalence of water intake and urine voiding 3 times or more during a shift (p < 0.001 for all McNemar’s tests). In study (5), we found the exposure group were younger and had shorter employment durations compared to the comparison group (p < 0.05 for two-sample t test). The exposure group had a higher prevalence of abnormal concentrated urine (24.0% vs. 4.1%, p < 0.001 for χ2 test) and had an adjusted odds ratio of 12.6 using the comparison group as the reference.
Conclusions: Whereas the humidity in clean room working environments is not very low, for workers living in a high humidity environment, the relatively low humidity may still cause dry symptoms of the eye, nose, and throat. The prevalence of tear secretion dysfunction in clean room female workers engaged in light-on tests is high. The use of contact lens may further increase the risk. And UTI is common among pregnant clean room workers, and frequent voiding appears to be a protecting factor. The interventions had achieved behavior modification and decreases in the prevalence of UTI. For ultra-low humidity working environment, we found USG is a good biomarker for evaluating the hydration status of workers. If a worker does not have proper occupational protection and adequate fluid supply, he or she may have concentrated urine or even dehydration state and other adverse health effects.

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