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Anaesthesiology
Occupational Health and Well-Being
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
9 sections · 199 slides
Overview
- Scope of this topic
- Roadmap of the topic
Physical hazards of the workplace
- Definition and relevance of ergonomics
- Human factor shortcomings and alarm fatigue
- Thermal environment of the operating room
- Draught, illumination and glare
- Waste anaesthetic gases in room air
- NIOSH recommended exposure limits
- NIH-set occupational exposure limits for anaesthetic gases
- NIH-set occupational exposure limits for anaesthetic gases (continued)
- NIH-set occupational exposure limits for anaesthetic gases (continued)
- NIH-set occupational exposure limits for anaesthetic gases (continued)
- Situations where exposure limits are exceeded
- Proper work practices for managing waste anaesthetic gases
- Origins of concern about waste gas toxicity
- Genotoxicity studies
- Early reproductive outcome studies
- The 1985 ASA meta-analysis
- Scavenging and the risk of spontaneous abortion
- Non-anaesthetic causes of adverse reproductive outcome
- Current position on reproductive risk and cognition
- Volatile anaesthetics and greenhouse gas emissions
- Composition and filtration of surgical smoke
- Health effects of surgical smoke exposure
- Gaps in surgical smoke protection
- Recommended controls for surgical smoke
- N95 filtering facepiece respirator
- Nature and dose limits of ionising radiation
- Occupational dose limits for ionising radiation
- Routes and trends in radiation exposure
- Deterministic and stochastic radiation effects
- Cancer risk and principles of radiation protection
- Shielding and dose measurement points
- Non-ionising radiation and magnetic fields
- Permissible noise exposure limits
- Noise intensity and acceptable exposure limits
- Recommended hospital noise levels and actual sources
- Noisiest periods and effects on performance
- Noise-induced hearing loss and other hazards
- Music in the operating room
- Practical rule for theatre music
Interpersonal issues, night call and fatigue
- Communication failure and patient safety
- Conflict in high-intensity clinical areas
- Production pressure
- Sleep requirement and causes of fatigue
- Health consequences of chronic sleep deprivation
- Fatigue and worker performance
- Evidence linking fatigue to medical error
- Studies showing no effect of fatigue on outcome
- Sleep deprivation patterns on night call
- Fatigue and anaesthetic outcomes
- Time-of-day effects and self-reported error
- Why fatigue is hard to link to outcome
- Regulation of resident duty hours
- Mitigation of fatigue when long hours are unavoidable
Substance use disorder
- Definitions and substances abused
- Distinctive danger of intravenous drug abuse
- Early recognition of addiction
- Signs of substance abuse and dependence in anaesthesia practice
- Mortality from substance use disorder
- Legal framework and cultural barriers
- FSMB and NAM guidance on stigma
- Random drug screening as a prevention strategy
- Factors linked to relapse
- Contents of a reentry contract
- Predictors of successful and unsuccessful reentry
- Controlled substance accounting and patient harm
- Priorities for reducing substance use disorder
Infectious hazards
- Sources and drivers of occupational infection risk
- Principal protective strategies
- Hand hygiene as the primary defence
- Origin and scope of universal precautions
- The two tiers of infection control
- CDC infection control guidelines and resources
- CDC infection control guidelines and resources (continued)
- CDC infection control guidelines and resources (continued)
- Updated CDC transmission-based precautions
- OSHA Bloodborne Pathogens Standard
- Safe disposal of sharps
- Burden and routes of respiratory viral illness
- Human respiratory syncytial virus
- Classification of influenza viruses
- Influenza vaccination of health care workers
- Influenza pandemics, containment and avian influenza
- Severe acute respiratory syndrome
- Outcome of SARS-CoV-1 and COVID-19 protection
- American Society of Anesthesiologists COVID-19 infection control resources
- American Society of Anesthesiologists COVID-19 infection control resources (continued)
- American Society of Anesthesiologists COVID-19 infection control resources (continued)
- American Society of Anesthesiologists COVID-19 infection control resources (continued)
- American Society of Anesthesiologists COVID-19 infection control resources (continued)
- Rapid antigen self-testing for SARS-CoV-2
- Viraemia, antigenaemia and immune response in acute SARS-CoV-2 infection
- Reading the SARS-CoV-2 testing timeline
- Common enteric pathogens by group
- Prevention of occupationally acquired infections
- Prevention of occupationally acquired infections (continued)
- Prevention of occupationally acquired infections (continued)
- Prevention of occupationally acquired infections (continued)
- Prevention of occupationally acquired infections (continued)
- Prevention of occupationally acquired infections (continued)
- Prevention of occupationally acquired infections: detailed guidance
- Prevention of occupationally acquired infections: detailed guidance (continued)
- Herpes simplex virus infection
- Herpetic whitlow and herpes simplex in pregnancy
- Varicella-zoster virus: two distinct diseases
- Clinical features of varicella and zoster
- Communicability and isolation for varicella-zoster
- Varicella immunity and exposure management in staff
- Epstein-Barr virus
- Cytomegalovirus epidemiology and pregnancy risk
- Rubella and congenital rubella syndrome
- Establishing rubella immunity in staff
- Documentation of measles immunity
- Measles transmission and medical settings
- Types and clinical spectrum of viral hepatitis
- Reported acute hepatitis cases and estimated infections, United States 2012 to 2019
- Reading the hepatitis surveillance panels
- Hepatitis A epidemiology and prophylaxis
- Natural history of hepatitis B infection
- Serological markers of hepatitis B
- Risk of hepatitis B after percutaneous exposure
- Occupational acquisition of hepatitis B
- Hepatitis B vaccination of anaesthesia personnel
- Hepatitis C virus and its markers
- Natural history of hepatitis C infection
- Occupational transmission and prevention of hepatitis C
- The family Retroviridae
- Natural history of HIV infection
- Risk of HIV transmission after occupational exposure
- Exposure routes carrying HIV risk
- Documented occupational HIV seroconversions in the United States
- Exposure risk during anaesthetic procedures
- Safety-engineered devices
- Determinants of occupational HIV risk
- US Public Health Service recommendations for HIV postexposure prophylaxis
- Follow-up testing and causes of prophylaxis failure
- Nature and propagation of prions
- Neuropathology and instrument decontamination in prion disease
- Global burden of tuberculosis
- Transmission of Mycobacterium tuberculosis
- Causes of tuberculosis outbreaks in health care facilities
- Preventing tuberculosis spread to anaesthesia personnel
- Anaesthetic management and staff screening in tuberculosis
- Operating room with anaesthesia machine and monitoring
Impairment, ageing and mortality
- Definitions of impairment and disability
- Relationship between impairment and work disability
- Causes of physician impairment
- Consequences of normal ageing
- Skills enhanced and skills compromised with age
- Evidence on age and professional competence
- Age and outcomes among anaesthesiologists
- Retirement decisions among anaesthesiologists
- Causes of death and longevity among anaesthesiologists
- Suicide risk among anaesthesiologists
- Stigma and licensure barriers to mental health care
Psychological considerations and well-being
- Occupational stress and its consequences
- The second victim after an adverse event
- Findings of the 2012 survey of ASA members
- Coping, culture and psychological safety
- Stress and burnout as distinct entities
- The three domains of the Maslach Burnout Inventory
- Prevalence of burnout among physicians
- Support, health and practice consequences of burnout
- Well-being as a professional obligation
- Obesity, activity and nutrition in health care workers
- Definition and effects of mindfulness
- Workplace culture and physician well-being
- Stanford model of professional fulfilment
- ASA Statement on Creating a Culture of Well-Being
- Conclusions on workplace safety and well-being
Key points
- Key points: workplace, vigilance and waste gases
- Key points: fatigue and substance use disorder
- Key points: infection, immunisation and culture
References
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- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition