美國職場肌肉骨骼職業病預防指引與我國比較

Comparison of the Guidelines Used to Prevent Musculoskeletal Disorders in the Workplace in the US and Taiwan

肌肉骨骼疾病具有多重致病因，是臺灣最常見的職業病，對勞工、企業或國家社會之影響甚鉅。本文介紹美國職業安全衛生署職場肌肉骨骼職業病預防指引核心內容，並與臺灣指引比較討論。美國職場肌肉骨骼職業病預防指引內容包括：管理階層提供支持、結合工作者參與、提供訓練、辨識危害、鼓勵早期通報肌肉骨骼症狀、危害應對、及追蹤成效等項目；分別從法遵性質、多元預防、危害辨識評估、行業別適用等面向進行討論，綜合建議我國職場肌肉骨骼職業病預防指引：1.各必要項目執行內容宜採取開放性原則認列；2.可加強管理階層支持、工作者參與、早期通報、行政管理及勞工教育訓練等多元策略；3.可引用職業病認定參考指引來設定預防閾值與警戒值；4.依職場危害高低決定投入資源多寡。期待透過法令的修訂與執行，逐步建立職場肌肉骨骼疾病的務實預防與管理機制。

Musculoskeletal disorders (MSD) have multiple factorial origins. They are at the top of the occupational diseases listed in the Taiwan labor insurance system and cause significant effects on workers, industries, and society as a whole. The present article introduces the essential content of the US OSHA guidelines related to prevention of musculoskeletal disorders in the workplace and compares them to Taiwan's guidelines set forth in the ergonomics hazard prevention program. The US OSHA guidelines comprise the following categories: ＂provide management support＂, ＂involve workers＂, ＂provide training＂ ＂identify problems＂ ＂encourage early reporting of MSD symptoms＂, ＂implement solutions to control hazards＂, and ＂evaluate progress＂. They were compared and discussed based on compulsory obligations, multiple strategies, hazard recognition and assessment, and industry differences. We concluded and suggested that Taiwan guidelines might include the following points: 1. adoption of the openness principle for the required regulatory items, 2. enforcement of multiple strategies, including managerial support, worker involvement, early reporting, administrative controls, and training, 3. establishing responses and setting danger thresholds referring to the guidelines for identification of occupational diseases in the Labor Insurance Program, 4. implementing the program according to the degree of occupational hazards in the workplace. We are looking forward to the revised regulations in order to sequentially create practical prevention and management of musculoskeletal disorders occurring in the workplace.