Occupational Hazard

In , legal limits for environmental levels were published in the Control of Substances Hazardous to Health Regulations COSHH as doubts about potential adverse health effects persisted. Emphasis was placed on the need for control measures including good anaesthetic practice, frequent changes of theatre air and gas scavenging. Despite these precautions atmospheric pollution will still occur in some clinical situations, for example inhalation induction, mask ventilation and leaks around uncuffed paediatric tracheal tubes. In , the British Medical Association reported that an estimated 1 in 15 doctors will suffer with a form of alcohol or drug dependence at some point in their lives.

However, surveys from the US indicate that anaesthesiologists were over represented among physicians monitored for substance abuse disorders. The exact prevalence of substance abuse among anaesthetists in the UK and Ireland is unknown; however, in a survey of anaesthetic departments published in , clinical directors reported cases of drug or alcohol abuse over a yr period where action was taken.

Alcohol abuse featured more commonly in those above 40 yr; drug abuse alone, most commonly opioids, benzodiazepines, or both, was more prevalent in those below 40 yr. Substance abuse and dependence is a complex issue. Within anaesthesia, specific risk factors when combined with an individual's genetic predisposition may precipitate the development of chemical dependence.

Anaesthetists are unique in the fact that they give drugs directly to the patient rather than prescribing them for others to administer. This along with ready access to a wide range of potent psychoactive drugs and a detailed knowledge of pharmacology are factors in the development of drug dependence. Dependence on highly lipid soluble opioids such as fentanyl develops rapidly and an affected individual requires ever increasing doses of the drug as tolerance develops. Anaesthetists usually work alone and may feel they have less control over their professional lives than colleagues in other specialities while the requirement to work anti-social hours may contribute to conflict in an individual's personal life.

The nature of anaesthesia means mistakes can have potentially catastrophic consequences and, in an increasingly litigious society, the threat of medicolegal proceedings can be an enormous burden. Consideration of non-professional pressures e. Signs and symptoms of alcohol and drug related problems are often insidious in onset and difficult to identify. An individual may be able to conceal successfully a drug or alcohol problem from family members and colleagues; job performance is often the last area to be affected. Presentation may occur with non-work related episodes such as a conviction for driving under the influence of drink, drugs, or both, reports of prescribing irregularities or, in extreme cases, death from drink or drug related causes such as overdose or suicide.

Direct observation of self-administration confirms the diagnosis but is not common. More subtle changes in an individual's appearance and behaviour can often be identified by family members and colleagues as drug or alcohol related problems develop. While none is diagnostic, the signs and symptoms listed in Tables 2 and 3 may alert others to the development of chemical dependence in an individual.

Education of all personnel should allow early identification and treatment of anaesthetists with a drug or alcohol related problem, so appropriate treatment can be instigated before serious consequences have occurred, either for the individual or their patients. Denial is often the first response shown by an affected individual when they are presented with concerns or evidence of dependence.

However, all anaesthetists have a duty of care to patients and colleagues alike. Accessible protocols allowing confidential reporting of suspected or actual drug abuse, alcohol abuse, or both must be followed. Returning to work after treatment for a drug or alcohol related problem may be particularly difficult if the workplace was felt to have been a contributory factor in the original problem.

However, anaesthetists do successfully manage to return to work with random testing used to monitor abstinence. A study performed in the US and published in found that, between and , the standardized mortality ratio for all causes of death in anaesthetists was 0. However, compared with a control group of physicians, anaesthetists had an increased mortality risk attributable to suicide, deaths related to drugs, HIV, cerebrovascular disease and other external causes. Most studies support a higher risk of suicide in doctors when compared with other professionals.

When compared with the general population, the relative risk of suicide for doctors is 1. Evidence also suggests that anaesthetists are at higher risk of suicide when compared with other medical specialities; the relative risk of suicide was 1. Stress is an inevitable factor in professional and personal life and can lead to negative health effects, both mental and physical. Moderate levels of stress are an important driving factor in optimizing performance, but prolonged and excessive levels of stress, coupled with inadequate coping mechanisms, can lead to decreased job satisfaction, impairment of decision making and even suicide.

Individual personality type is a significant factor in the development of stress. Sources of frustration and conflict may originate from domestic or professional life but they rarely occur in isolation and are often interrelated. Stress has also been identified as a precipitating factor in the development of alcohol and drug misuse. The management of stress hinges on the recognition of its nature and causes, and an understanding of how individuals respond. Modifications to lifestyle can then be made before clinical skills become impaired.

Human physiology dictates circadian patterns of alertness and performance and includes a vital need for sleep. Sleep loss and disruption of circadian rhythm can lead to reduced attention and vigilance, poor memory, impaired decision making, prolonged reaction time and disrupted communications. Workload pressures, insufficient numbers of personnel and increasing complexity of procedures compound the problem for doctors. Many studies have shown that fatigue reduces medical task performance.

ECG interpretation and intubation skills have been shown to be reduced among emergency room physicians working night shifts when compared with similar staff working day shifts, and fatigue was listed as a factor contributing to 2. These brief, uncontrolled and spontaneous episodes of physiological sleep may last seconds or minutes and the individual may not be aware of them.

However, they can reduce performance sufficiently to create safety risks. Other factors exaggerating the detrimental effects of fatigue include hypovolaemia, hypoglycaemia, alcohol and drug use, poor general health and concomitant use of some prescription medications. Recommendations to maintain alertness are listed in Table 5. Chronic fatigue may also affect an individual's physical health. The incidence of cardiovascular disorders is increased in shift workers and appears to be related to the number of years of exposure.

However, there is no conclusive evidence that sleep deprivation in shift work leads to chronic ill health.

occupational hazard

Strategies to reduce fatigue-related incidents include relief planning, regular and rehearsed equipment checking routines, improved workplace design including drug ampoule and syringe labelling protocols and regulation of working hours. Although there is no doubt that the number of hours worked has been reduced, the effect of this change on levels of fatigue remains to be seen.

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Equipment All Journals search input. Close mobile search navigation Article navigation. This article was originally published in. Types of exposure with a significant potential to transmit HIV 3. Go to bed earlier than normal. Muticenter study of contaminated percutaneous injuries in anaesthesia personnel. Morbidity and early retirement among anaesthetists and other specialities.

Please see multiple choice questions 9— Also, three 3 relevant references obtained from citation tracking where included in the final review. This summed up to a total forty six 46 papers for the review. Figure 1 shows literature selection process.

Occupational Hazards

The findings extracted from the selected studies in the final review were analyzed thematically. The synthesized findings were categorized into appropriate themes according to the major occupational hazards prevailing among HCWs in developing countries. This revealed the following themes: Lee observed that majority of occupational acquired blood borne diseases by HCWs were as a result of needle stick injuries [ 15 ]. These findings were consistent with studies by Orji et al. Additionally, improper disposal of medical waste such as needles and other sharps has been found to cause injuries on HCWs which can also transmit blood borne diseases [ 10 ].

Lee in argued that the increase in acquisition of blood borne diseases by HCWs in developing countries is due to the high prevalence of HIV, HBV and HBC, hence making them more likely to acquire such blood borne diseases [ 15 ]. Also, the lack of a comprehensive vaccination coverage among HCWs against HBV, poor use or non-availability of post-exposure prophylaxis PEP and lack of adherence to standard safety infection control measures such as use of gloves, washing of hands and usage of disinfectants increases the risk of transmission of blood borne diseases [ 15 , 17 ].

Tuberculosis TB is a major public health problem and an occupational hazard affecting HCWs in developing countries [ 18 - 22 ].

List of occupational hazards and work prohibited to minors – Riigi Teataja

The transmission of this disease according to Baussano et al. In rural India, Pai et al. Several factors accounts for the increase in Tuberculosis among HCWs. Healthcare workers who worked in health facilities with a high ratio of Tuberculosis patients per health worker were at an increased risk of LTBI [ 20 ]. Studies have also reported that HCWs who had worked for over ten years were at greater risk than their counterparts who worked for lesser years.

It was also observed that HCWs who worked in locations within the health facility such as laboratories, tuberculosis inpatient wards, general medicine unit and emergency units were at an increased risk of acquiring LTBI because they are more likely to spend more time with Tuberculosis patients than their peers in administrative section of the facility [ 22 , 24 ]. The recognition of TB as an occupational hazard in developed countries brought about the emergence of Multidrug Resistant TB MDR-TB in health establishments thus leading to the development of effective infection control measures implemented for the reduction of TB transmission [ 23 ].

Workplace-related hazards

However, implementing infection control measures in developing countries are too expensive as a result of limited resources coupled with the lack of sufficient evidence of its efficacy in countries with high prevalence of TB, hence, detection of TB cases and treatment are done using the Directly Observed Treatment Short-course DOTS strategy, which limits infected HCWs from performing their usual task during the treatment process [ 23 ]. Likewise, in developing countries, HCWs do not have any form of access to self-protection when handling infected TB patients, therefore resulting in them avoiding contacts with such patients which may lead to suboptimal care of the patients [ 25 ].

These studies revealed high prevalence of musculoskeletal problems among HCWs.

Healthcare workers had experienced at least one or more symptoms of MSD over the previous twelve months. These disorders were associated with prolonged standing postures, continuous movements and the use of force during work. More so, it was noted that all practitioners above 45 years of age had musculoskeletal problems; hence, increased age was found as a risk factor for MSD.

Also, HCWs who attended to more than 40 patients per working day complained of musculoskeletal symptoms [ 27 , 28 ]. Most commonly affected areas among HCWs with musculoskeletal problems were the neck followed by the lower back, shoulders and wrists [ 28 ]. This is contrary to findings by other studies which reported the lower back as the most common site followed by the neck [ 26 , 27 ]. Factors responsible for musculoskeletal problems were frequent lifting or transferring of dependent patients, bending, treating large number of people; working in the same position for long hours; prolonged standing posture, performing manual therapy and psychological stress [ 26 - 28 ].

Others requested for sick leave, hospital admissions and reduction in work activity and leisure activity [ 26 - 29 ]. Karahan in argued that more than half of the healthcare workers received medication while 4. In order to cope with musculoskeletal pains, some HCWs developed the habit of adjusting their position and or the position of their patients which includes adjusting bed height.

They also chose appropriate techniques best suitable for their comfort rather than causing discomfort. Requesting for assistance when handling patients was part of the measures adopted. This made some HCWs more likely to select methods best suitable for their comfort at work rather than meeting the needs of their patients [ 27 ]. Work-related stress have been identified as a common occupational hazard prevailing among HCWs in developing countries [ 16 , 30 , 31 ].

The Researchers argue that the demanding nature of work performed by HCWs is responsible for stress that they suffer. Work-related stress was associated with excess workload, long working hours, numerous shift duties and a high number of patient attendances. Similarly, a study conducted in Pakistan demonstrated that more than half of HCWs had experienced stress in the line of duty.

Furthermore, occupational stress among HCWs has been argued to be responsible for high level of job burnout [ 32 ]. Younger nurses were more at risk of experiencing high burnout than their older counterparts. Additionally, nurses working in the surgical department tend to be more exposed to occupational stress as compared to their peers in other departments as they were more likely to stand for longer hours during work. Burnout during work among HCWs was observed to cause physical fatigue, emotional exhaustion, depersonalization and psychosomatic problems which increased feelings of failure [ 30 ].

Other effects of work-related stress reported were alcohol intoxication, drug abuse, poor job satisfaction and stress induced hypertension [ 16 ]. These negative effects of work-related stress prevent HCWs from achieving effective work performance. The prevalence of latex allergy among HCWs have revealed that latex allergy occurs from daily usage of gloves which is a major source of occupational hazard among HCWs [ 33 , 34 ]. In Sri-Lanka, a study revealed that These findings were in conformity with studies by Ozkan and Gokdogan in Turkey who found the prevalence of latex allergy among HCWs to be Healthcare workers who worked in emergency units were 4.

It was also observed that HCWs who wore gloves for a period of an hour and above within a working day were at an increased risk of latex allergy [ 33 ]. In addition, workers who had close contact with those who wore gloves complained of having persistent symptoms of latex allergy reactions which lasted for a year. Researchers have shown that violence in the workplace is a significant problem among HCWs in developing countries [ 36 - 40 ]. The common type of violence faced by HCWs are verbal and physical as observed by Celik et al.

These findings were similar to studies by Bob et al. Also, Khademloo et al. Additionally, the rate of verbal and physical abuse were higher among nurses who were graduates as they were more likely to discuss their problems with their fellow HCWs which tends to cause conflict between them and their perpetrators [ 40 , 41 ]. However, Bob et al.