[Hazard assessment and occupational safety measures in surgery : Relevant knowledge on occupational medicine]

Making Our Hospitals a Safe Workplace: Hazard Identification and Risk Assessment at a Tertiary-Level Public Hospital in Eastern India

BACKGROUND

Hospitals are complex places with a large number of employees, patients, furniture, equipment, etc. Healthcare workers (HCWs), patients, or the general public are vulnerable to injuries and illness due to unseen hazards at the workplace. This study aims to identify the hazards and assess the risks at a hospital to ensure safety for HCWs, patients, and the public and generate awareness about the same. It helps in reducing the financial obligation of the institution due to the treatment of illnesses of staff, absenteeism, and service disruption and slows down manpower turnover. Hazard Identification and Risk Assessment (HIRA) helps reduce human errors and promote safe behavior.

OBJECTIVE

This study aims to identify and study the hazards in a hospital, assess the risks associated with the hazards, and recommend methods to reduce or eliminate the hazards based on the outcomes of the study.

METHODOLOGY

An observational study was conducted at a 1000-bed tertiary-level teaching public sector hospital in eastern India. A checklist was used for direct observation, conducting staff interviews, and document reviews. A risk scoring tool was used, and hazards were ranked as per the risk score.

RESULTS

Thirty-eight hazards were identified in the study and classified under the categories of natural, physical, chemical, biological, ergonomic, psychological, and safety. The fire risk and occurrence of cyclones had the highest risk scores.

CONCLUSIONS

The study identified hazards through direct observations, record reviews, and staff interviews. These findings can guide the prioritization of areas requiring necessary action in risk reduction, ensuring a safe workplace for healthcare workers (HCWs), patients, and the public. They can also help the institution shift from a reactive approach to a proactive method for HCW safety.

[Against the mental stress-Resilient work in surgery]

BACKGROUND

Surgery represents a challenging medical discipline.

AIM

This article focuses on psychological stress in surgery and explains resilience as a protective factor against the consequences of psychological stress, based on selected literature references and own relevant clinical experiences. In this context, the sense of coherence, social support and self-efficacy expectation are discussed in more detail as resilience factors.

METHOD

Narrative review.

RESULTS (CORNER POINTS)

Surgery is classified as a challenging medical subspecialty with a high reputation but associated with diverse and varied physical and psychological stress factors. Stress factors differ individually in terms of requirements (can be overdemanding or underdemanding but also stimulating, relevant to learning and meaningful, thus positively or negatively stressful) and resources (potentially beneficial working conditions, experience, or behavior, e.g., social support, scope for action). Fluctuations within surgical specialties and a high dropout rate during residency training are well known and the causes include high psychological stress. In the case of persistent and at the same time insufficient compensation of work stress caused by a lack of or insufficient resources, these can be associated with mental illnesses. Nonetheless, many physicians spend their entire lives working in hospital or private surgical settings and remain healthy, a strong sense of resilience to mental illness may be fundamental to this. Resilience can be present as a personal characteristic or it can be learnt through a process or adapted through positive or negative influences, thus strengthening the personal characteristics. Overall, data on surgeon resilience or interventional studies in resilience research in the surgical setting are limited and provide another research gap. Resilience training (directed at a sense of coherence, social support, strengthening knowledge of coping skills, positive emotions, optimism, hope, self-efficacy expectations, control beliefs or robustness), also clearly indicated in the "robust" medical specialty of surgery, is always individual and should not be generalized. If the surgeon cannot retrieve sufficient resources due to the stressful situation, stress management with its methods is helpful to reduce the psychological stress and to be able to maintain the performance and health of this person.

CONCLUSION

The consolidation of resilience as a notable aspect of employee management. In collegial interactions, resilience must be based on workplace-based approaches to strengthen coping mechanisms in the face of work stress. Workplace-related stress should also be perceived, addressed and counteracted within the organization, certainly also as an elementary management task.

[Working in the Operating Theatre - What does the Surgeon Need to Know About Occupational Medicine?]

Surgery is associated with numerous health hazards for the staff.The aim of this article is to show the risks to the health and ability to work of surgical staff and the possibilities for improving occupational health and safety in terms of behavioural and situational prevention, as well as secondary and tertiary prevention, especially with regard to cooperation with the occupational physician.The brief narrative overview is based on the author's own occupational medicine, surgery and interdisciplinary experience from daily practice and selective references from the current medical-scientific literature, using the example of the operating theatre work area.The possible activity-related health hazards and the risks to the working ability of medical staff as well as the possibilities for occupational health and safety in the sense of behavioural and situational prevention are an important matter in the interdisciplinary status of surgery that should not be underestimated (since it is also partly determined by law). Above all, this discipline must responsibly dedicate itself to the points of contact with occupational medicine (in addition to acquiring its own knowledge from the surgical side).

Activation of the stress response among the cardiac surgical residents: comparison of teaching procedures and other (daily) medical activities

BACKGROUND

The aim of this Pilot study was to investigate the cardiac surgical residents' workload during different surgical teaching interventions and to compare their stress levels with other working time spent in the intensive care unit or normal ward.

METHODS

The objective stress was assessed using two cardiac surgical residents' heart rate variability (HRV) both during surgical activities (32 selected teaching operations (coronary artery bypass graft n = 26 and transcatheter aortic valve implantation n = 6), and during non-surgical periods. Heart rate, time and frequency domains as well as non-linear parameters were analyzed using the Wilcoxon test.

RESULTS

The parasympathetic activity was significantly reduced during the surgical phase, compared to the non-surgical phase: Mean RR (675.7 ms vs. 777.3 ms), RMSSD (23.1 ms vs. 34.0 ms) and pNN50 (4.7% vs. 10.6%). This indicates that the residents had a higher stress level during surgical activities in comparison to the non-surgical times. The evaluation of the Stress Index during the operations and outside the operating room (8.07 vs. 10.6) and the parasympathetic nervous system index (- 1.75 to - 0.91) as well as the sympathetic nervous system index (1.84 vs. 0.65) confirm the higher stress level during surgery. This can be seen too used the FFT Analysis with higher intraoperative LF/HF ratio (6.7 vs. 3.8).

CONCLUSION

HRV proved to be a good, objective method of identifying stress among physicians both in and outside the operating room. Our results show that residents are exposed to high psychological workloads during surgical activities, especially as the operating surgeon.

Awareness of hazard risks and prevention among orthopaedic surgery residents in South East Nigeria

Background:

Objectives:

Materials and Methods:

Results:

Conclusion:

Recommendation:

[What (general/abdominal) surgeons should know about occupational medicine? : General vaccine recommendations and postexposure prophylaxis of hepatitis B, C and HIV]

This article deals with the general recommendations on vaccination and postexposure prophylaxis, which can be utilized for cuts and needlestick injuries. Cuts and needlestick injuries among surgeons are common occupational accidents. These should be interpreted as acute or emergency situations, especially if there was contact with infectious index patients or the danger of infection cannot be excluded. This results in high economic costs but also in the individual confrontation with an infectious disease that is definitely incurable. The aim of this review is to highlight the general and occupational vaccine recommendations for surgeons. In addition, background information and legal principles are presented. There is a duty to provide and to obtain information about effective protective measures against infectious diseases from cuts and needlestick injuries even for surgeons. In addition, primary prophylaxis, vaccination recommendations, and postexposure prophylaxis after cuts and needlestick injuries as well as the TOP principle are presented. The TOP principle comprises technical, organizational and person-related protective measures.

[The suffering surgeon-How do German surgeons protect themselves? : Survey of the German Society of General and Visceral Surgery on the extent of occupational safety measures and health burden among German surgeons]

BACKGROUND

There are few data on how surgeons implement occupational safety measures to protect their own health and how they assess their subjective health burden.

OBJECTIVE

In times of a shortage of surgeons it makes sense to examine these relationships in order to evaluate future-oriented adjustments to increase the attractiveness of the profession of "surgeon".

MATERIAL AND METHODS

An online questionnaire was sent to the registered members of the German Society for General and Visceral Surgery (DGAV) in October 2016. The members were asked about the application of occupational safety measures, individual living conditions, working conditions and the subjective health burden depending on the level of training and type of hospital (basic, standard, maximum care).

RESULTS

The response rate was 21% (1065/5011). Occupational safety measures were not strictly implemented: routine use of dosimeters, thyroid radiation protection, smoke extraction and protective goggles only took place in 40% (427/1065), 39% (411/1065), 10% (104/1065) and 5% (55/1065), respectively. The majority of surgeons (51%, 548/1065) rated their lifestyle as unhealthy. The majority of them are senior physicians, 46% (250/548) consider their job to be a health hazard. The proportion of chief physicians and assistant physicians is only 21% (115/548) and 18% (98/548).

CONCLUSION

Guidelines for standardizing the perioperative protection of German surgeons are desirable. Health-promoting behavior could have a positive effect on the occupational safety of surgeons and ultimately also on patient safety. This can contribute to increasing the attractiveness of the profession "surgeon" in the long term.

Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis

Importance

Physicians in procedural specialties are at high risk for work-related musculoskeletal disorders (MSDs). This has been called "an impending epidemic" in the context of the looming workforce shortage; however, prevalence estimates vary by study.

Objectives

To estimate the prevalence of work-related MSDs among at-risk physicians and to evaluate the scope of preventive efforts.

Data Sources and Study Selection

Systematic search in MEDLINE (Ovid), Embase (Elsevier), Web of Science, PubMed (National Center for Biotechnology Information), and 2 clinical trial registries, without language restriction, for studies reporting on the prevalence and prevention of work-related MSDs among at-risk physicians published until December 2016. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for meta-analyses and systematic reviews of observational studies were used. At-risk physicians were defined as surgeons and medical interventionalists. Studies reporting on specific disorders or pain assessed with validated instruments were included.

Data Extraction and Synthesis

Study characteristics; disease prevalence for the neck, shoulder, back, and upper extremity; and measures of resulting disability were recorded. Study estimates were pooled using random-effects meta-analytic models.

Main Outcomes and Measures

Career prevalence of injuries and 12-month prevalence of pain.

Results

Among 21 articles (5828 physicians [mean age, 46.0 years; 78.5% male; 12.8 years in practice; 14.4 hours performing procedures per week]) included in this systematic review and meta-analysis, pooled crude prevalence estimates of the most common work-related MSDs were degenerative cervical spine disease in 17% (457 of 2406 physicians) (95% CI, 12%-25%), rotator cuff pathology in 18% (300 of 1513 physicians) (95% CI, 13%-25%), degenerative lumbar spine disease in 19% (544 of 2449 physicians) (95% CI, 5%-16%), and carpal tunnel syndrome in 9% (256 of 2449 physicians) (95% CI, 5%-16%). From 1997 to 2015, the prevalence of degenerative cervical spine disease and degenerative lumbar spine disease increased by 18.3% and 27%, respectively. Pooled prevalence estimates for pain ranged from 35% to 60% and differed by assessment instrument. Of those with a work-related MSD, 12% (277 of 2319 physicians) (95% CI, 7%-18%) required a leave of absence, practice restriction or modification, or early retirement. Heterogeneity was considerable for all crude analyses (mean I2 = 93.5%) but was lower for sensitivity analyses (mean I2 = 72.3%). Interventions focused on products and behaviors. Twelve at-risk specialties described a gross lack of awareness and an unmet need for ergonomics education.

Conclusions and Relevance

Prevalence estimates of work-related MSDs among at-risk physicians appear to be high. Further research is needed to develop and validate an evidence-based applied ergonomics program aimed at preventing these disorders in this population.