Workplace Violence Against Primary Care Clinicians: A Narrative Review.

Workplace violence (WPV) is a commonly reported occupational hazard in healthcare and its prevalence is increasing. WPV occurs in all types of practice settings, but little is known about WPV in primary care settings in the United States (US). Because primary care practice settings differ from the inpatient settings, further examination of WPV in primary care is warranted. Our objective was to summarize the available literature highlight important gaps. We conducted a search using Pubmed and OVID for US studies of WPV in US-based adult primary care practices. Studies including only pediatric populations were excluded. Due to the lack of available literature conducted in US primary care settings, we expanded our search to include international studies. We identified 70 studies of which 5 were US based. Due to the lack of significant numbers of US-based studies, we opted to conduct a narrative review of all available studies. The evidence shows that WPV is a common occurrence in primary care settings in many countries and that the majority of primary care clinicians have experienced at least some form of non-physical violence in their careers. Most of the studies conducted were cross-sectional in design and reported on both non-physical and physical forms of WPV. There was not a consistent trend between genders in experiencing the major forms of WPV, but women were consistently more likely to be subjected to sexual harassment. Potential root causes for WPV could generally be categorized as patient-level, clinician-level, clinical encounter specific, and operational root causes. While most WPV was found to be non-physical, it still had significant emotional and job-related impacts on clinicians. These troubling results highlight the need for further studies to be conducted in the US.

Association between occupational noise exposure level and pure-tone audiometry abnormalities among Metropolitan Manila Development Authority employees: A cross-sectional study.

Traffic enforcers are exposed to various occupational health and safety hazards, including noise pollution, which may lead to occupational hearing loss. This cross-sectional study aimed to estimate the prevalence of hearing loss and to assess the relationship between occupational noise exposure level (ONEL) and abnormalities in air conduction thresholds among Metropolitan Manila Development Authority (MMDA) employees along Epifanio delos Santos Avenue, Philippines. Eight-hour ONELs were measured among 108 participants working with greater than 5 years of service. Participants had hearing evaluations using pure tone audiometry (PTA) to calculate the prevalence of hearing loss. Generalized linear models with a Poisson distribution were fitted to estimate the association between ONEL and audiologic abnormalities, controlling for confounding factors. Approximately 16% of employees had hearing loss. The prevalence of hearing loss was higher with ONEL exposures greater than 85 A-weighted decibels (dBA), with traffic enforcers exposed to higher ONELs than office workers. ONELs greater than 85 dBA were related to audiologic abnormalities at different frequencies in PTA. The prevalence of audiologic abnormalities at 4000 Hz and 6000 Hz was 48% higher (adjusted prevalence ratio [aPR], 1.48; 95% CI, 1.12-1.96) and 25% higher (aPR, 1.25; 95% CI, 1.00-1.55), respectively, among participants with ONELs greater than 85 dBA than with ONELs less than or equal to 85 dBA. Participants exposed to ONELs greater than 85 dBA, more likely traffic enforcers, may have increased risk of audiologic abnormalities. Regular ONEL monitoring is warranted for occupational risk assessment of traffic enforcers. A hearing conservation program may need to be considered for this population. Additional studies are needed to determine trends in hearing deterioration among traffic enforcers.

A novel comprehensive radiation shielding system eliminates need for personal lead aprons in the catheterization laboratory.

OBJECTIVES: This clinical study evaluated the efficacy of a novel radiation shielding system for the cardiac catheterization laboratory designed to provide comprehensive protection that obviates the need for personal lead aprons. BACKGROUND: Invasive Cardiologists are exposed to occupational health hazards related directly to radiation exposure (RE) and indirectly to the orthopedic burden of wearing only partially protective lead aprons. Innovations to reduce these risks are warranted. A novel comprehensive shielding system (ProtegoTM , Image Diagnostics Inc, Fitchburg, Ma) has been validated in pre-clinical studies to provide excellent radiation protection, sufficient for the State of Michigan to certify it for use without need for personal lead aprons. METHODS: This clinical analysis measured RE to a single Physician operator utilizing the ProtegoTM shield (and not wearing personal lead apron) during routine cardiac catheterization procedures (diagnostic and interventional). RE was measured at both thyroid and waist level with a real-time dosimetry system (RaysafeTM , Billdal, Sweden), calculated on a median per case basis (mrems). Additional parameters collected included procedure type, access site, per case fluoroscopy time, and patient factors including body mass index. RESULTS: In n=98 cases (25% diagnostic, 75% interventional including 22% chronic total occlusions), median/case RE was 0.4 mrems (thyroid) and 0.2 mrems (waist). RE=0 in 12 cases. In no case did radiation exposure exceed 3.2 mrems. CONCLUSION: The ProtegoTM shield system provides excellent RE protection to the Physician operator, without the need for personal lead aprons and has the potential to reduce catheterization laboratory occupational health hazards.

Comprehensive interventions to reduce occupational hazards among medical staff in the pathology department of five primary hospitals.

OBJECTIVE: To explore comprehensive interventions to reduce occupational hazards among medical staff in the pathology department of five primary hospitals. METHODS: The indoor air quality in the pathology department of five primary hospitals and the health status of staff were investigated and analyzed. Formaldehyde and benzene concentrations in the technical and diagnostic rooms of the pathology departments were analyzed before and after comprehensive interventions. The Environmental Protection Agency risk assessment paradigm was used to assess the health risks from occupational exposure to benzene and formaldehyde. Consequently, considering the local environment, targeted comprehensive intervention measures were developed, including optimizing management, raising awareness, updating equipment, and replacing reagents. RESULTS: Eye discomfort was higher among technicians in the pathology department than among clinical medical staff (P < 0.05). Before comprehensive interventions, formaldehyde concentrations were higher in the technical room than in the diagnostic room at the five primary hospitals (P < 0.05). However, compared to before interventions, formaldehyde and benzene concentrations in both rooms were significantly lower after comprehensive interventions. Furthermore, although medium risks of occupational exposure to benzene and formaldehyde remained in both rooms before and after comprehensive interventions, the risk values before interventions were higher than after comprehensive interventions. The staff of the technical rooms showed higher risk values that those of the diagnostic rooms before and after comprehensive interventions. Similarly, although hazard quotient (HQ) values for occupational exposure to benzene and formaldehyde were < 1 in both the technical and diagnostic rooms before and after comprehensive interventions, with lower noncarcinogenic risks, the values were higher before than after comprehensive interventions. Moreover, staff in the technical room had higher HQ values before and after comprehensive interventions than those in the diagnostic room. The use of environmentally friendly reagents for the preparation of frozen sections was effective. CONCLUSION: Comprehensive interventions significantly reduced occupational hazards among staff at the pathology department of five primary hospitals, which is of great practical significance to protect the health of staff.

Knowledge and practice of radiation safety in Brazilian equine veterinarians are less than optimal: An online survey.

Exposure to ionizing radiation is an occupational risk for veterinarians due to the potential for carcinogenesis, reproductive disorders, cataracts, and hereditary genetic changes. This survey study aimed to identify the radiological protection practices routinely used by veterinarians who work with portable digital X-ray equipment in horses in Brazil and assess their knowledge regarding current legislation. A total of 120 voluntary participation questionnaires were sent to veterinarians who used portable digital radiographic equipment in horses nationwide. The frequencies of the answers were analyzed using the chi-square test and logistic regression models. Thirty-five veterinarians responded (29% response rate). Of these, there was a greater participation of professionals in public institutions (40%, 14/35, p < .001), with 69% from the southeast region (24/35, p < .001) and 69% (24/35, p = .028) being male. We found that self-employed veterinarians had a higher odds ratio (OR) (9.00; 95% confidence interval (CI) [1.39-58.44]; p = .021) of not using personal protective equipment compared with those in professional public institutions. In addition, not knowing the current legislation Collegiate Directorate Resolution 611/22 was a potential risk factor for lower radiological protection (OR, 8.00; 95% CI, [0.79-81.33]; p = 0.079). In conclusion, findings indicated that Brazilian equine veterinarians generally do not adopt adequate radiological protection against ionizing radiation during radiographic examinations and have low knowledge of the current legislation. Results can be used as background for the formulation of specific radiation protection guidelines for veterinarians and incentive educational and training strategies to reduce risks inherent to occupational exposure.

Indian Perspective of Burnout Among Plastic Surgeons.

Introduction Over the last decade, the term "Burnout" has become familiar term in all walks of life, particularly medicine. Emotional exhaustion, depersonalization, and a low sense of personal accomplishment make up the triad. At least a third of plastic surgeons are having burnout according to the western literature. Data on burnout in Indian plastic surgeons is lacking. We have made an attempt to analyze the incidence and factors responsible for burnout among plastic surgeons in India. Materials and Methods An online survey was conducted in India to assess burnout among plastic surgeons from June to November 2019. Consent, demographic information, stress-related factors, the abbreviated Maslach Burnout Inventory (aMBI), and Satisfaction with Medicine were all included section wise in the survey. Both used scales were validated. Data were gathered using Google forms, then uploaded to an Excel file and analyzed. A multivariable and univariable analysis of factors associated with burnout was carried out. Results Twenty-two percent of 330 plastic surgeons who responded were assessed to have moderate to high emotional exhaustion, 5% had moderate to high depersonalization, and 3% had low personal accomplishment. The overall burnout rate was 8.2%. Seventy-three percent of plastic surgeons enjoyed a good to very good quality of life. Great over-volume of work, mid-career practicing plastic surgeons and professional satisfaction with work were found to have a significant association with burnout on multivariate analysis. Conclusions Plastic surgeons in India suffer an overall burnout rate of 8.2% with a multifactorial etiology. This occupational hazard is preventable and reversible. Plastic surgeons need to be vigilant about this and seek help whenever required.

[Design for online monitoring of occupational hazard factors based on internet of things].

At present, there are disadvantages with the detection for occupational hazard factors, such as insufficient monitoring data, poor timeliness, weak representativeness, long detection cycles, and inability to continuously monitor. Taking advantages of internet of things technology, an online monitoring platform for occupational hazard factors has been designed. The platform collects the concentration (intensity) of hazard factors through sensors, transmits the occupational hazards data collected online in realtime. The online monitoring cloud center for occupational hazard factors processes and analyzes online monitoring data in realtime, stores the hazard factors data to form database management, and provides user application services to form an intelligent online monitoring service model for occupational hazard factors. Based on the online monitoring platform of occupational hazard factors, multi-level government health supervision departments and employers can grasp the status of hazard factors in real time, which is conducive to improving the level of occupational hazard supervision.

[The facility design and operation effect of control vehicle emissions hazard in test section of automobile assembly workshop].

The hazard of vehicle emissions mainly come from the four wheel positioning, drum test and vehicle emissions test sections in automobile assembly workshop, which can lead to abnormal hemoglobin and hepatic insufficiency in workers. We researched on preventing toxic gases technologies for the vehicle emissions generated by these three sections, designed the ventilation facilities, and then detected and evaluated the operation effect, thereby improving the working environment, ensuring the occupational health of workers, and providing scientific basis for the control of vehicle emissions hazards.

Suspended lead suit and physician radiation doses during coronary angiography.

OBJECTIVE: This study was performed to evaluate physician radiation doses with the use of a suspended lead suit. BACKGROUND: Interventional cardiologists face substantial occupational risks from chronic radiation exposure and wearing heavy lead aprons. METHODS: Head-level physician radiation doses, collected using real-time dosimeters during consecutive coronary angiography procedures, were compared with the use of a suspended lead suit versus conventional lead aprons. Multiple linear regression analyses were completed using physician radiation doses as the response and testing patient variables (body mass index, age, sex), procedural variables (right heart catheterization, fractional flow reserve, percutaneous coronary intervention, radial access), and shielding variables (radiation-absorbing pad, accessory lead shield, suspended lead suit) as the predictors. RESULTS: Among 1054 coronary angiography procedures, 691 (65.6%) were performed with a suspended lead suit and 363 (34.4%) with lead aprons. There was no significant difference in dose area product between groups (61.7 [41.0, 94.9] mGy·cm2 vs. 64.6 [42.9, 96.9] mGy·cm2 , p = 0.20). Median head-level physician radiation doses were 10.2 [3.2, 35.5] µSv with lead aprons and 0.2 [0.1, 0.9] µSv with a suspended lead suit (p < 0.001), representing a 98.0% reduced dose with suspended lead. In the fully adjusted regression model, the use of a suspended lead suit was independently associated with a 93.8% reduction (95% confidence interval: -95.0, -92.3; p < 0.001) in physician radiation dose. CONCLUSION: Compared to conventional lead aprons, the use of a suspended lead suit during coronary angiography was associated with marked reductions in head-level physician radiation doses.

Occurrence and outcome of blood-contaminated percutaneous injuries among anesthesia practitioners: a cross-sectional study.

BACKGROUND: Anesthesia practitioners are at risk for percutaneous injuries by blood-contaminated needles and sharp objects that may result in the transmission of human immunodeficiency virus and hepatitis viruses. Reporting these injuries is important for the early prevention and management of blood-borne infections. OBJECTIVE: To investigate the occurrence, reporting, characteristics and outcome of contaminated percutaneous injuries (CPIs) in anesthesia residents, fellows and faculty. METHOD: A cross-sectional anonymous survey electronically distributed to all 214 anesthesia practitioners at a large academic multihospital-based anesthesia practice in Florida, USA. RESULTS: The overall response rate was 51% (110/214) (60% (50/83) for residents, 50% (8/16) for fellows and 45% (52/115) for anesthesia faculty). Fifty-nine percent (65/110) (95% confidence interval (95% CI): 5068) of participants reported having one or more CPIs during their years of anesthesia practice (residents 42% (95% CI: 2955), fellows 50% and faculty 77% (95% CI: 6688)). The number of CPIs per anesthesia practitioner who answered the survey was 0.58 for residents, 0.75 for fellows and 1.5 for faculty. Within the last 5 years, 35% (95% CI: 2644) of participants had one or more CPIs (39% of residents, 50% of fellows and 29% of faculty). CPIs in the last 5 years in faculty older than 45 years of age were 12% (3/25) compared to 44% (12/27) in faculty younger than 45 years of age.Analyzing data from practitioners who had one CPI revealed that 70% (95% CI: 5585) reported the incident at the time of injury (residents 85%, fellows 100% and faculty 58%). Hollow-bore needles constituted 73.5% (95% CI: 5988) of injuries. As per participants' responses, 17% (18/103) of CPIs received postexposure prophylaxis and there were zero seroconversions. CONCLUSION: Based on our study results, most anesthesia practitioners will sustain a CPI during their years of practice. Despite some improvements compared to historic figures, the occurrence of CPIs continues to be high and reporting of percutaneous injuries remains suboptimal among anesthesia residents. A fifth of injuries in the perioperative setting is from an infected source and requires postexposure prophylaxis. Although no infections were reported due to CPI exposure in this study, findings underscore the need for more education and interventions to reduce occupational blood exposures in anesthesia practitioners and improve reporting.

Estimating mortality from coal workers' pneumoconiosis among Medicare beneficiaries with pneumoconiosis using binary regressions for spatially sparse data.

BACKGROUND: Coal workers' pneumoconiosis (CWP) is an occupational lung disease due to inhalation of coal dust. We estimated mortality from CWP and other pneumoconioses among Medicare beneficiaries. METHODS: We used the 5% Medicare Limited Claims Data Set, 2011-2014, to identify patients diagnosed with ICD-9-CM 500 (CWP) through 505 (Asbestosis, Pneumoconiosis due to other silica or silicates, Pneumoconiosis due to other inorganic dust, Pneumonopathy due to inhalation of other dust, and Pneumoconiosis, unspecified) codes. We applied binary regression models with spatial random effects to determine the association between CWP and mortality. Our inferences are based on Bayesian spatial hierarchical models, and model fitting was performed using Integrated Nested Laplace Approximation (INLA) algorithm in R/RStudio software. RESULTS: The median age of the sample was 76 years. In a sample of 8531 Medicare beneficiaries, 2568 died. Medicare beneficiaries with CWP had 25% higher odds of death (adjusted OR: 1.25, 95% CI: 1.07, 1.46) than those with other types of pneumoconiosis. The number of comorbid conditions elevated the odds of death by 10% (adjusted OR: 1.10, 95% CI: 1.09, 1.10). CONCLUSION: CWP increases the likelihood of death among Medicare beneficiaries. Healthcare professionals should make concerted efforts to monitor patients with CWP to prevent premature mortality.

Occupational Hazards to the Joint Replacement Surgeon: Radiation Exposure.

BACKGROUND: Intraoperative fluoroscopy is an essential tool to assist orthopedic surgeons in accurately and safely implanting hardware. In arthroplasty cases, its use is on the rise with the increasing popularity of the direct anterior (DA) approach for THA. However, exposure of ionizing radiation poses a potential health risk to surgeons. While the benefits of intraoperative fluoroscopy in DA THA is becoming clearer, and are well-described in the literature, the potential health dangers associated with career-long cumulative radiation exposure are rarely discussed. METHODS: In this article, we review the available literature to discuss radiation safety in orthopedics with a focus on total joint arthroplasty. We present the basic science of radiation, discuss the amount of radiation exposure in orthopedic surgery, and review the potential health risks associated with long-term exposure. CONCLUSION: Overall, the radiation dose exposure to arthroplasty surgeons is low and within recommendations for occupation exposure limits. However, due to the stochastic health impacts of ionizing radiation, there is no threshold dose below which radiation exposure is truly safe. Therefore, it is imperative that surgeons practice proper fluoroscopy safety habits, such as wearing proper protective equipment, minimizing fluoroscopy time and magnification, and maximizing distance from the radiation source to minimize the life-long cumulative radiation exposure and associated health risks.

Assessment of the effects of solvents on lung function among paint industry workers in Mauritius.

The study aimed to determine the respiratory effects of solvents among workers in the Mauritius paint industry. A total of 388 participants were selected using simple random sampling, and were subjected to a questionnaire for data collection. Lung function test was performed using a spirometer. Multiple regression was used to analyze the relationship between hours of exposure to solvents, while adjusting for socio-demographic factors. Independent t-test was also used to identify any difference between the means of lung function tests and the two exposed groups. Male participants were found less likely exposed to solvents compared to females (AOR, 3.39, CI 1.97-5.81). Those with secondary and lower secondary education, and worked for ≤12 hours per week, had an increased likelihood of being exposed to solvents (AOR 2.95, CI 1.20-7.28) (AOR 2.48, CI 1.19-5.16). Participants who were aware of occupational hazards (AOR 0.15, CI (0.05-0.46), and have used PPE (AOR 0.14, CI 0.08-0.25) were less likely to be less exposed to solvents. This study highlights the adverse effects of workplace exposures on respiratory health among paint factory workers. .

Association of occupational exposure to pesticides with overweight and abdominal obesity in family farmers in southern Brazil.

The association of chronic exposure to pesticides with overweight and abdominal obesity in adult farmers was investigated. This cross-sectional study included a random sample of 122 farmers and their family members of both sexes (61% were male), living in the municipality of Farroupilha, southern Brazil. Pesticide groups and their individual compounds were self-reported and classified according to major functional and chemical classes (never used, 1-20 years, or > 20 years of use). Abdominal obesity and overweight were the outcomes of interest. A multivariate Poisson regression model was analyzed. After confounding factors were controlled, chronic use (>20 years) of insecticides (PR: 1.45; 95% CI: 1.00-2.10) and organophosphorus pesticides (PR: 1.48, 95% CI: 1.02-2.12) was associated with a higher prevalence of overweight but not abdominal obesity. Additional studies are needed to confirm our findings and clarify the specific mechanisms of these pollutants in the etiology of obesity.

Infection-Control knowledge, attitude, practice and risk perception of occupational exposure to COVID-19 among dentists: A cross-sectional survey.

Background: COVID-19 is a potentially fatal disease that was announced as a global pandemic at the beginning of the year 2020. Aim: The purpose of our cross-sectional study was to evaluate the infection-control knowledge, attitude, practice, and risk perception of occupational exposure to COVID-19 among multinational dentists. Patients and Methods: A self-designed, 33-item, English questionnaire was created and distributed through social media and digital communication platforms. The questionnaire covered the demographic data, knowledge and perception of the occupational risk of the COVID-19 infections, and compared some infection control measures taken before and after this global pandemic. The results were analyzed, and four scores were used to assess the aforementioned parameters. Results: A total of 300 multinational dentists answered our survey, with the majority being females (59%) and aging from 25 to 44 years old (68%). We found that a statistically significant relationship exists between attitude and nationality, country of practice, medical condition, and the practicing specialty (P < 0.05). In addition, risk perception had a statistically significant correlation with nationality, smoking habits, education level, and specialty (P < 0.05). Furthermore, there was a statistically significant correlation between the practice score and the gender, age, smoking habits, education level, nature of the practice (private or governmental), and academia affiliation (P < 0.05). Conclusions: The study sample had good compliance with the instructions and guidelines of the World Health Organization (WHO) and the Centre for Disease Control (CDC), with most of them improving their infection control precautions after the virus's emergence according to the said guidelines. Furthermore, our participants were fearful of the COVID-19 virus and the fact of being potential transmitters. Despite saying that, the significant majority of them reported being confident in treating COVID-19-positive patients.

[Investigation on occupational hazard factors in teaching and research places of a university].

Objective: To investigate and monitor the occupational hazards in the Teaching and Research Laboratory (hereinafter referred to as the place) of a university, so as to provide basis for the occupational health work in the university. Methods: November 2014, 46 places in a university were selected by stratified random sampling, and the occupational health risk factors were investigated. Results: Indoor temperature, humidity, sulfur dioxide, nitrogen dioxide, carbon monoxide and carbon dioxide were detected in 21 sites, xylene and hydrofluoric acid were detected in 6 sites, and colony count was detected in 18 sites, the power frequency electric field intensity was measured in 23 places, and the x-ray radiation dose was measured in 4 places. Noise was measured at 21 sites, with 7 sites exceeding the standards accounting for 33.3% (7/21) ; 21 sites were detected for illumination and 10 sites for nonconformity accounting for 47.6% (10/21) ; 10 sites for Microwave Radiation and 3 sites exceeding the standards accounting for 30% (3/10) ; and 25 sites were detected for outdoor air volume and air velocity, the percentage of unqualified was 72% (18/25) in 18 sites, among which the wind velocity was statistically significant in teaching, research and experimental sites (P=0.010) . Conclusion: The occupational hazards in the teaching and research places of a university should be paid attention to, and the engineering protection and personal protection should be strengthened in the experiment.

[Analysis of dust hazard characteristics in 59 ferrous metal foundry enterprises in Ningbo City].

Objective: To analyze the post distribution of dust concentration in ferrous metal foundry enterprises and evaluate the occupational health risks, and provide basis for policies of the formulation of pneumoconiosis prevention and control. Methods: From August to September in 2020, the basic information, dust hazard information and occupational health management information of 59 ferrous metal casting enterprises were investigated, the dust concentration distribution was analyzed, and the risk assessment was carried out by using the quantitative assignment model. The dust concentration is tested by LSD method after logarithmic treatment. The 3 times time weighted average allowable exposure concentration of dust is taken as the peak concentration limit of dust; The time weighted average allowable exposure concentration of dust converted by exposure time is taken as the time weighted average exposure concentration limit of dust, and whether the time weighted average exposure concentration and peak concentration of dust at the same post exceed the limit is taken as the basis for exceeding the limit of dust post concentration to calculate the post exceeding the limit rate. Results: The dust hazards were mainly distributed in the posts of sand treatment, molding, sand falling, sand cleaning and cutting and grinding. Dust exposure time weighted average concentration was 0.44 (0.03, 5.11) mg/m(3), peak exposure concentration was 1.30 (0.18, 10.94) mg/m(3), and the over standard rate of Posts was 38.92% (79/203) . Weighted average exposure concentration of other dust (total dust) in the cutting and grinding post is 1.50 (0.15, 7.40) mg/m(3), peak exposure concentration is 0.90 (0.07, 12.48) mg/m(3), and the post exceedance rate is 4.88% (2/41) . Weighted average exposure concentration of silica dust (exhaling dust) in dust operation posts of investment casting enterprises is 0.43 (0.05, 6.35) mg/m(3), peak exposure concentration is 0.90 (0.12, 8.28) mg/m(3), and the post over standard rate is 35.77% (49/137) ; Weighted average exposure concentration of other dust (total dust) at the cutting and grinding post is 2.00 (11.00, 21.00) mg/m(3), and the post exceedance rate is 2.50% (2/80) . There was no significant difference in the concentration of respirable dust between sand casting and investment casting (P>0.05) . The concentration of respirable dust in sand casting was higher than that in sand treatment, molding and sand cleaning posts (P<0.05) . The concentration of silica dust in investment casting was higher than that in sand treatment and molding posts, and that in sand cleaning posts was higher than that in sand treatment posts (P<0.05) . 98.48% (454/461) of the dust operation posts have an occupational health risk value greater than or equal to 400, and 1.52% (7/461) of the dust operation posts have an occupational health risk value of 200~399. Conclusion: there is a high rate of exceeding the standard in the dust work posts in the ferrous metal foundry enterprises in Ningbo, and the workers have a high occupational health risk of pneumoconiosis or metal and its compound pneumoconiosis. Targeted measures should be taken to reduce the occupational health risk.

Evaluation of the environmental contamination and exposure risk in medical/non-medical staff after oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy.

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a technique to directly deliver chemotherapeutic drugs in the abdomen for the treatment of peritoneal metastases. Pressurization improves the treatment efficacy but increases the risk of exposure for the medical/non-medical staff who can be exposed by dermal or ocular contact, or inhalation of aerosols containing the cytotoxic drugs. The aim of this study was to evaluate the risk of exposure for the medical/non-medical staff (nurses, surgeons, anaesthesiologists and cleaning personnel; n = 13) during PIPAC with oxaliplatin performed according to the protocol recommended in France. Blood samples were collected 1 h before and immediately after PIPAC, and urine samples 1 h before, and then 3 h and the morning after PIPAC. In the control, non-exposed group (n = 7), only one urine and blood sample were collected. Surface contamination in the operating room was assessed in water- and Surfanios-impregnated wipe samples. The total elemental platinum in each sample was quantified by inductively coupled plasma mass spectrometry, using a method adapted to quantify trace amounts (ng.L-1) in very low volumes (100 µl). No surface contamination was detected. Although 25% of urine samples in the exposed group contained platinum, no statistical difference was observed in urine and plasma samples collected before and after PIPAC and with the control group samples. These findings suggest that the French PIPAC protocol does not increase the risk of exposure to platinum in all staff categories involved. This protocol could be considered in future occupational policies and consensus statements. Trial registration: NCT04014426.

Airborne human papillomavirus (HPV) transmission risk during ablation procedures: A systematic review and meta-analysis.

BACKGROUND: Human Papillomavirus (HPV) is associated with development of oropharyngeal cancer. Aim of this review was to assess airborne transmission risk of infectious particles from HPV lesions to airway mucosa of medical staff during established ablation procedures. METHODS: A systematic review of human and animal studies, published before 09/2020, relevant to airborne HPV transmission. Controlled studies reporting prevalence of HPV-associated upper airway (nasal/oral/pharyngeal) disease in staff performing ablation procedures (laser, loop electrosurgical excision [LEEP], cryosurgery) on HPV lesions were included in meta-analysis. Additionally, we aimed for a comprehensive systematic overview of studies regarding occupational risk of airborne HPV transmission and safety measures during ablation procedures. RESULTS: A total of n = 30 original studies report outcomes related to HPV transmission risk in medical staff conducting ablation procedures. HPV DNA detection in ablation smoke (n = 7), matching HPV genotypes on ablated HPV lesions and face/airways of medical staff after ablation (n = 2), and evidence for infectivity of papillomavirus in ablation smoke (n = 3, animal models only) were reported. Three case reports describe occupational HPV disease of upper airway mucosa. Three controlled studies assessed warts (in CO2 laser-users only); when pooling all controls (general population, non-laser users), nasal/oral/pharyngeal lesion sites were more common amongst laser-users (OR = 5.75; 95%CI[1.55, 21.38]; p < .001). DISCUSSION: Airborne HPV dispersal with matching "high-risk" HPV-genotypes in airways of medical staff after ablations (LEEP and CO2-laser) and cases of HPV-associated upper airways neoplasms based on exposure to laser and LEEP smoke are documented. Upper airway mucosa is a more common anatomical site for warts in CO2 laser users compared to controls. Simple safety measures greatly reduce HPV contamination and transmission risk.

Electronic Health Record-Related Stress Among Nurses: Determinants and Solutions.

Background: Documentation and navigation through electronic health records (EHRs) is an essential, but stressful, task. We present the magnitude, determinants of such events, and solutions proposed by nurses to address EHR-related stress (EHR-S) at a tertiary eye hospital in Saudi Arabia. Methods: Nurses of an eye hospital were surveyed in 2019 about EHR-S. A Likert scale was used to assess the responses of 10 components of EHR-related work. The total score was graded as follows: minimum (<-10), mild (<0 to -10), moderate (1-10), and severe (>11). The score was correlated with determinants. Solutions suggested by nurses to reduce stress were reviewed. Results: This survey covered 212 nurses. Of them, 106 (50%; 95% confidence interval: 43.3-56.7) reported EHR-S. The median EHR-S score was -3.0 (interquartile range: -9.0; +8.0). Thirty-five (16%) nurses reported severe EHR-S. Senior nurses (M-W, p < 0.02) and those working in emergency and recovery units (M-W, p < 0.01) had statistically higher EHR-S. The main stressors were incomplete EHR work by other departments affecting nursing care (70.8%), difficulty in correction after entering the data (60.4%), and difficulty in data retrieval (60.4%). The main solutions to reduce EHR-S were to reduce the frequency of changes to configuration of the EHR (58%), more training (54.2%), and appreciation of good work (52.8%). Conclusions: EHR-S is experienced by half of the nurses working at an eye care hospital. Implementation of solutions such as better training and fewer changes to the EHR system could reduce stress levels of nurses.