This document discusses occupational hazards faced by anesthetists. It begins by outlining course objectives to understand hazards and minimize risks. It then explores various types of hazards including chemical (anesthetic gases), radiation, infectious diseases, and physical risks. Specific health risks from exposure like fatigue and effects on performance are examined. The document provides details on minimizing different hazards through techniques like gas scavenging and personal protective equipment.

1. Course Objectives
Understand the basic concepts of professional hazards
Gives maximal concern to minimize professional
hazards of anaesthesia
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2. Why hazards to Anaesthetist?
• It is impossible to practice anesthesia without
exposure to a number of potentially harmful
environmental factors.
• Escape of anesthetic vapors into the operating room
atmosphere is unavoidable
• Exposure to inhalation agents, transmissible
diseases, and radiation are unavoidable in the
operating room environment.
• Occupational exposure to radiation comes primarily
from x-rays scattered by the patient and surrounding
equipment.
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3. Cont…
• Fortunately, the past several decades have produced
a number of technical advancements and guidelines
that serve to minimize the adverse effects of these
occupational exposures.
• Efficient gas scavenger systems, needle-less systems,
protect IVs, and post-exposure prophylaxis (PEP)
protocols are now commonplace in anesthesia
practice.
• But while these measures all serve to minimize
occupational exposure and risk, they do not
completely eliminate them.
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4. Types of Hazards to Anaesthetist
–Chemical
–Radiation
–Electrical
– Physical
–Infectious diseases
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5. Discus on
Physical hazards to anaesthetist
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6. Chemical hazards
• Trace amounts of waste gases enter the operating
room atmosphere each time an inhaled anesthetic is
delivered.
• Waste nitrous oxide and halogenated anesthetics in
the absence of scavenging may approach
concentrations as high as 3000 and 50 ppm,
respectively.
• Mask inductions, circuit disconnects, the use of
laryngeal mask airways and cuffless endotracheal
tubes all contribute to operating room contamination.
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7. Cont…
• While the exposure to anesthetic gases is more
common in pediatric anesthesia .
• Mask inductions and uncuffed endotracheal tubes are
the standard of care in pediatric anesthesia .
• The introduction of the laryngeal mask to anesthesia
practice has increased operating room exposure to
waste gases in adult cases as well.
• The universal use of scavenging systems can lead to a
false sense of security among operating room
personnel.
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8. Cont…
• Because anesthesia machines are not equipped to
recognize unconnected scavenging systems, a failure
of the system may not be readily apparent.
• Simply transferring the p/t from the operating room
to the PACU does not eliminate the risk of exposure to
waste gases, as p/ts continue to exhale trace amounts
of N2O for 5 to 8 hours after arrival in the PACU.
• If the anesthetic can be smelled, concentration of
volatile agents is well above the maximum
recommended level.
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9. Cont…
• Thus it is important to accurately detect, measure, and
limit ambient anesthetic levels in order to minimize
passive exposure of operating room personnel to
waste gases.
• The National Institute for Occupational Safety and
Health (NIOSH) does not currently regulate exposure
to N2O and halogenated agents, the agency does
provide guidelines designed to minimize workplace
exposure
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10. • The possibility that chronic exposure to
anesthetic waste gases could result in adverse
health effects
• Health Risks
• Fatigue
• Effect on Performance
• Impact on physician well-being
• Infection
• Latex Allergy
• Additional Stressors
• Chemical Dependence
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11. Health Risks
• Chronic exposure to anesthetic waste gases could
result in adverse health effects was first appreciated
in the late 1960s when a report of potential harm
appeared in the Russian literature
• In 1967, Vaisman reported an increased
incidence of abortions among female
anesthetists.
• Specifically, this study noted 18 spontaneous
abortions in 31 pregnancies
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12. Effect on Performance
• There are many researches done on effect of
concentrations of nitrous oxide and other
inhalational agents using volunteers but many of
them disprove the decrement of psychomotor
performance.
• Thus there is no definitive cut-off in which
psychomotor performance is depressed
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13. Radiation
• There is routine exposure to both ionizing and non
ionizing electromagnetic radiation in OR
• Ionizing radiation has enough energy to create both
free radicals and ionized molecules which are
enough, to destroy tissues or chromosomal changes
may cause malignant growth.
• Non ionizing radiation may excite electrons to move
from the ground state to higher orbitals in molecules,
but the electrons remain in the molecule.
• In this case, damage to tissues may result from the
heat produced by the absorbed radiation.
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14. Ionizing Radiation: X-rays
• Exposure to radiation occurred mostly in the
operating room with the use of portable fluoroscopy
and x-ray machines
• Occupational exposure to radiation comes primarily
from x-rays scattered by the patient and the
surrounding equipment.
• The advancement of endovascular surgery has led to
an explosion of procedures performed in the
radiology suite, significantly increasing exposure of
anesthesia personnel to ionizing radiation.
• The amount of radiation generated during
fluoroscopy depends on how long the x-ray beam is
on.
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15. Cont…
• To a minimize use Film badges, although not protective,
provide a means of monitoring exposure.
• Because the intensity of scattered radiation is inversely
proportional to the square of the distance from the
source, the best protection is physical separation.
• A distance of at least 3 feet from the patient is
recommended. Six feet of air provides protection the
equivalent of 9 inches of concrete or 2.5 mm of lead.
• Although they are uncomfortable, aprons containing the
equivalent of 0.25 to 0.5 mm of lead sheet are effective in
blocking most scattered radiation and such devices are
recommended to be worn whenever there is an exposu
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16. Non ionizing Radiation: Lasers
• Lasers- acronym for light amplification by stimulated
emission of radiation.
• Lasers produce infrared, visible, or ultraviolet light.
• Although the radiation from lasers is non ionizing, it is
potentially unsafe both because of its intensity and
because of the matter released from tissues during
treatment.
• Lasers are used in many surgical specialties,
including ophthalmology, plastic surgery,
gynecology, neurosurgery, urology, head and
neck surgery, and gastrointestinal surgery.
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17. Cont…
• The radiation is usually infrared or visible light and is
created in a “laser medium” that is stimulated by
high-intensity energy to release photons of identical
wavelength.
• Eye injuries are the greatest risk to personnel working
near lasers.
• To minimize risks Protective eyewear is designed to
filter out the radiation produced by a specific type of
laser while still permitting vision.
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18. Cont…
• The type of protection provided by a given filter is
marked on the frame of the goggles and should be
checked before use.
• Filters that are scratched should not be used.
• Protective eyewear is recommended for all personnel
because reflected radiation can be as hazardous as
direct radiation and the intensity is not diminished
significantly in the distances traveled in the average
operating room.
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19. Infection
• Minor finger cuts and scratches increases the risk of
transmission of Blood-Borne Pathogens
• Exposure to blood and other body fluids containing
• HB and C virus
• HIV
• Tuberculosis
• Precaution and treatment
• Vaccination and post exposure prophylaxis
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20. Cont…
• Intact DNA from (HPV), Human immunodeficiency
virus (HIV), proviral DNA has been found in laser
smoke produced by vaporizing cultures of HIV-
positive cells DNA.
• Although these experiments, which used tissue
cultures, do not replicate the clinical situation, they
stress the importance of strict attention to smoke
removal.
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21. Cont…
• With adequate evacuation and filtration using
equipment specifically designed to scavenge such
vapors, it is unlikely that operating room personnel
will be contaminated by laser-dispersed HPV.
• Though not conclusive, the Tissue from the
surgeon's laryngeal tumors contained HPV DNA
types 6 and 11, was found that suggest the laryngeal
papillomas may have been caused by inhaled virus
particles.
• Hence, it is prudent to scavenge all vaporized debris.
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22. Standard precautions in infection prevention
• Physical: Personal protective equipment
(gloves, face masks, goggles, gowns, aprons, and
drapes)
• Mechanical: High-level disinfection (HLD) by boiling
or steaming and sterilization by autoclaving or dry heat
ovens
• Chemical: Antiseptics (alcohol-based antiseptic
agents) and high-level disinfectants (chlorine and
glutaraldehydes)
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23. Transmission-Based Precautions
• Transmission-based precautions should be followed
when p/ts are known to be or are suspected of being
infected with highly transmissible or epidemiologically
important pathogens.
• These precautions are based on the properties of
specific pathogens and are to be used in addition to
standard precautions.
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24. 1.Airborne precautions are to be used when
transmission of small particles or droplets (< 5 µm) is
likely.
• Because these particles can be carried for long
distances, special filtration and air handling are
necessary.
• Diseases in this category include
– measles,
– varicella, and
– tuberculosis.
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25. 2. Droplet precautions apply to diseases transmitted by
large particles (> 5 µm).
• Because of their size and the droplets do not remain
suspended in air, transmission is limited to short
distances; a meter or less.
• Examples are
– Invasive Haemophilus influenzae type b
– Meningitis and epiglottitis,
– Mycoplasma pneumoniae pneumonia,
– Streptococcal pharyngitis, and
– Rubella.
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26. 3. Contact precautions apply to direct skin-to-skin
contact, including hands.
• Indirect contact may also occur if surfaces in an
infected patient's environment are contaminated.
• Included are
– Colonies of antibiotic-resistant organisms,
– Hepatitis A virus,
– Herpes simplex virus,
– Viral conjunctivitis, and major abscesses.
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27. Fatigue and Physician Well-Being
• Sleep deprivation has been shown to have an
impact on physician well-being.
• Long and grueling work hours result in fatigue
• Well-defined periods of vulnerability to sleep have
been identified in humans.
• Sleep, and Public Policy of the Association of
Professional Sleep Societies has made the following
recommendations
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28. Cont…
1. Management should be made aware that
performance errors are more common between 1
and 8 AM.
2. Programs should be developed to identify signs of
sleep-related error.
3. Because inadequate sleep or irregular sleep
patterns enhance the tendency for error, work
hours should be limited to permit adequate sleep.
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29. Cont….
• In the practice of anesthesia, sleep deprivation may
have subtle effects on vigilance in the operating
room and may contribute to critical incidents.
• Regulation of Work Hours and regular vacation
should be considered as management in addition to
the other recommendation and standard
precaution .
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30. Additional Stressors
• Stress in the workplace continues
• Special causes included
– Professional relationships
– Work overload,
– Threats of litigation,
– Peer review,
– Increasing administrative responsibilities.
– Difficult anesthetic cases,
– The threat of professional liability, and the stress of
night call were all considered to be significant
causes of stress
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31. Cont…
• Perhaps more than any other medical specialty, the
practice of anesthesia requires uninterrupted
vigilance with immediate reaction to life-threatening
situations.
• An inappropriate response can prove to be acutely
fatal to an otherwise healthy patient.
• Management of stress is rarely addressed in
continuing medical education seminars for
anesthesiologists, but it should be.
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32. Cont….
• Stress is a universal phenomenon to which no one is
immune.
• Vital to our interactions with others is the ability to
recognize stressed behavior, not only in them but also
in ourselves.
• Healthy means of coping with stress include an ability
to communicate, appropriate assertiveness,
interactive management of conflicts, adequate time
with family, and time for recreational pastimes totally
unrelated to professional activities.
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33. Chemical Dependence
• Drug addiction has long been an occupational hazard in
the practice of medicine.
• The ASA Task Force on Chemical Dependencehas
identified the following characteristics of addicted
anesthesiologists:
• 50% are younger than 35 years
• Residents are overrepresented
• 76-90% abuse opioids as their drug of choice
• 33-50% are polydrug abusers
• 33% have a family history of addictive disease
• 65% are associated with academic departments
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34. “Drugs can not only lead to jail but it also does
harm to your health, We only have one body so
lets take care of it.
http://www.thinkslogans.com/slogans/anti-
drug-slogans/
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35. Why anaesthetist exposed to drug abuse?
• In addition to environmental exposures, the access to
potent opioids, the extended work hours, and the
unique role the anesthetist plays in critical clinical
situations contribute to the anesthetist's risk of
chemical dependence, and emotional distress.
Availability of drugs
Drug Potency
Previous use of drugs
Family history of drug abuse, as a risk factor
Genetic predisposition may contribute to the
progression from abuse to addiction
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36. Signs and Symptoms of Chemical
Dependence
• Pinpoint pupils, Weight loss, Found comatose and
found dead in addition they have signs and
symptoms
At work
• Unusual changes in behavior
• Anger , euphoria, depression
• Gossip by others
• Progressive increase in apparent narcotic use for
anesthetic management
• Preference for working alone
• Careless charting
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37. Cont…
• Frequent requests for bathroom breaks
• Unusual willingness to provide relief for others
• Inappropriate willingness to take calls
• Often appears in the hospital when not on call
• Frequent unexplained absences
• Excessive postoperative pain in patients cared for by
an individual
• Commonly wears long-sleeved gowns (to prevent
chills often seen in early withdrawal and to hide
needle tracks
• Witnessed self-administration
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38. At home
• Withdrawal from family, friends, and leisure activities
• Changes in behavior (e.g., wide mood swings)
• Fights and arguments at home
• Frequent unexplained illness (common in alcoholism)
• Gambling
• Extramarital affairs
• Legal problems (e.g., arrests for driving while
intoxicated)
• Decrease in sexual drive
• Drugs and syringes found in the home
• Odor of alcohol on breath
• Symptoms of withdrawal
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39. The end result of chemical dependency
Drug addiction
Suicidal attempts
Found comatose
Found dead
Thus Awareness is essential to safe
anesthesia practice.
So, “ Don’t Huff, Don’t Puff. Keep away from
that stuff!”
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40. Management and intervention
• Drug addiction in anesthesia can result in the loss of
one's job, profession, and family.
• Sadly, loss of life may be the first indication that
there is a problem.
• The mortality risk for anesthesiologists is no higher
than that for other medical specialties, their risk of
drug-related death and suicide is alarmingly high.
• Studies have shown a twofold increase in suicide
among U.S. white male anesthesiologists and British
(mostly female) anesthetists when compared with
appropriate population controls.
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41. • A recent study in the U .S reported the relative risk
of suicide in anesthesiologists to be 1.45 when
compared to internists.
• The relative risk of a drug-related death was even
higher at 2.79.
• All these studies identify drug-related death as a
significant occupational hazard in the practice of
anesthesia.
• Anesthetists are overrepresented in drug treatment
center.
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42. Management
• Management of physicians who are chemically
dependent includes
• Identification,
• Intervention,
• Referral for treatment, and
• Help with reentry.
• The department should have an established
mechanism in place to deal with impaired
Anaesthetist and anaesthesiologist.
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43. • Although many recovered anesthesiologists return to
the practice of anesthesia, there is a significant
relapse rate.
• The chance of relapse is highest in physicians who
become addicted to potent narcotics early in their
career.
• Successful recovery requires a lifelong commitment
to treatment.
• In some cases, a change in specialty is the only
solution.
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44. References:
• Clinical anaesthesia (Paul G. Barash
1989,1992)
• Anesthesia (Ronald D. Miller)
• Infection Prevention and Patient Safety Training
Resource Package Federal Ministry of Health,
Ethiopia, October, 2011
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45. Take care!!
“Half the modern drugs could well be thrown
out the window except that the birds might
eat them.” ~Martin H. Fischer, Fischerisms
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