Occupational hazard factors and protective countermeasures for medical staff with endoscopy

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Occupational hazard factors and protective countermeasures for medical staff with endoscopy

Author: Xu Hong

With the continuous development of endoscopic equipment and technology, the level of endoscopic diagnosis and treatment is generally improved, and the scope of application of endoscopic diagnosis and treatment is gradually expanded, showing its unique advantages and functions in various clinical disciplines. Because endoscopic minimally invasive diagnosis and treatment has the advantages of small trauma, fast recovery and reliable curative effect, more and more doctors and patients choose to diagnose, treat and follow up through endoscopy, and the amount of endoscopic diagnosis and treatment has increased dramatically. In order to prevent iatrogenic cross infection in the process of endoscopic diagnosis and treatment, countries all over the world have issued various operation guidelines and endoscopic cleaning and disinfection specifications, and organized relevant departments to carry out inspection, supervision and training. However, the occupational hazards faced by endoscopy medical staff under great clinical work pressure have not attracted enough attention from relevant departments and practitioners themselves. How to strengthen the occupational protection of endoscopic medical personnel, reduce occupational hazards and ensure occupational safety has become a problem that cannot be ignored. In this paper, the occupational hazards and protective measures of endoscopic medical personnel are reviewed as follows.

Occupational hazard factors of medical staff with 1. endoscopy

1. Biological Hazard Factors

Due to the particularity of the work, the relevant personnel engaged in endoscopic diagnosis and treatment will often come into contact with the blood, body fluids and excreta of patients, which undoubtedly increases the risk of occupational exposure of endoscopic medical personnel to a certain extent. Among them, Helicobacter pylori infection in the digestive tract is the most common. According to the research results, compared with other medical workers, the infection rate of Helicobacter pylori in endoscopic medical staff can be as high as 90%[1-5]. At the same time, due to China is a large country with liver diseases and a large number of hepatitis virus infections, the positive rate of hepatitis B virus surface antigen (HBsAg) in patients undergoing endoscopy has reached 6.73, which has become an important factor threatening the occupational safety of endoscopy medical staff [6]. In addition, with the prevalence of human immunodeficiency diseases (HIV) and syphilis (USR), the infection rate in the population is increasing year by year. Li Huicheng found in the survey that the positive detection rate of anti-HIV antibody in patients before endoscopic examination in China was 0.17, which has exceeded the infection rate of adults in low-level epidemic countries [7]. These pathogens can invade the body through the eye mucosa and damaged skin of medical personnel during endoscopic procedures, causing cross-infection [1,8]. At present, most hospitals in China no longer do blood biological pathogen detection before endoscopic diagnosis and treatment, which further paralyzes the vigilance of medical staff and increases the potential risk of infection.

2. Chemical hazard factors

Endoscopic medical personnel are also exposed to many harmful chemicals in their daily work, such as glutaraldehyde (GA), o-phthalaldehyde, peracetic acid, multi-enzyme lotion, formalin solution, and latex gloves. GA is one of the most widely used endoscopic disinfectants in China. As early as the 1990 s, foreign scholars Jachuck[9] and Calder[10] have pointed out that often

Endoscopic staff exposed to glutaraldehyde are prone to respiratory symptoms (eg, airway obstruction, cough, shortness of breath) and skin irritation. Later, it was mentioned that glutaraldehyde is the main cause of occupational asthma or fibrous lung disease in endoscopic medical staff [11]. In addition, in recent years, there have been many reports that latex gloves as protective equipment for endoscopic medical staff can cause medical staff to have latex allergic symptoms such as skin itching, urticaria, and allergic rhinitis.

3. Physical hazard factors

(1) sharp stab wounds: sharp stab wounds have always been an important occupational risk factor faced by medical staff in various departments. Due to the particularity of the working environment, if sharp stab wounds occur during operation, pathogens in the patient's blood, body fluids and excreta can enter the body through the stab site, greatly increasing the risk of infection. After investigating the occupational exposure of 32 medical staff in the endoscopy department of Zhumadian Central Hospital, Zhu Aiping found that there were cases of HCV infection due to sharp instrument injury during operation [12].

(2) Radiation injury: In the process of endoscopic diagnosis and treatment, especially in endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) and various digestive tract stent implantation, medical personnel are required to operate for patients in the radiation environment for a long time. Although there are certain protective measures, long-term exposure will still lead to autonomic nerve dysfunction, leukopenia, and decreased body resistance among endoscopic medical staff. In severe cases, it can also induce malignant tumors [13].

(3) Mechanical injury: Due to the long time consumption of some fine and complex surgical methods, the relative concentration of endoscopic diagnosis and treatment time, the increasing number of patients and the fast turnover of diagnosis and treatment, endoscopic medical personnel need to maintain a long-term fixed and standing posture and perform a single continuous repetitive afterburner action during the working process. Therefore, endoscopic medical personnel are the high-risk population of mechanical injury, lower extremity varicose veins, neck and back pain, frozen shoulder, carpal tunnel syndrome are more common occupational damage [14-17].

4. Personal and social factors

Compared with the rapid development of endoscopic technology, the relevant training of occupational safety protection and infection control of endoscopic Junior College in China is still in its infancy, and a sound and standardized management and supervision system has not been formed. A considerable number of endoscopic medical personnel have never even received relevant occupational safety protection and infection control knowledge training, or have not paid enough attention to them because of the lack of specific and powerful management measures and supervision means after receiving relevant training, no protective habits have been formed. However, the environmental pollution caused by the weak protection awareness and lack of protection habits of a small number of employees further increases the risk of occupational injury, which is an important factor affecting occupational safety. On the other hand, the heavy workload of diagnosis and treatment and the tense doctor-patient relationship also invisibly increase the psychological pressure of endoscopic medical staff, leading to psychological fatigue and job burnout [18].

Occupational Protection Countermeasures of Medical Staff with 2. Endoscopy

1. Protection against biological hazards

(1) Personal protective equipment: Many practices and studies have shown that adequate and scientific personal protective equipment can significantly reduce the incidence of infection in endoscopic medical staff. The new version of China's endoscopic operation specification also makes specific requirements for the protective clothing of personnel in different areas, so as to avoid contact with patients' body fluids, blood, excrement and disinfectant in different links of the operation process. Therefore, endoscopy departments should wear personal protective equipment as an indispensable part of the operation of diagnosis and treatment, strict requirements, strengthen supervision and management [19,20].

(2) Develop good hand hygiene habits: Maintaining good hand hygiene habits is a prerequisite for endoscopic medical staff to protect their own safety. Remove gloves and thoroughly clean hands before and after patient contact and when leaving the operating area at the end of the procedure [20]. In particular, patients with suspected or confirmed pathogen infection should be rinsed with soap and water, or cleaned with alcohol-refined hand sanitizer [21]. On the other hand, the operating platform or equipment frequently contacted by medical personnel should also be properly cleaned and disinfected on a daily basis to prevent pathogens from infecting other staff through contact transmission.

2. Protection against chemical hazardous factors

(1) reasonable layout of space: standardized endoscopic center or endoscopic examination room should be equipped with diagnosis and treatment area, medical staff office and rest area and endoscopic cleaning and disinfection area, each area through independent operation, reasonable layout can effectively control the spread of harmful chemicals. However, due to the imbalance of regional medical development, there is still a certain gap between the endoscopy Junior College of primary hospitals and provincial and municipal hospitals in terms of capital, equipment and scale, and the spatial layout and distribution can not be reasonable and scientific. Therefore, we should grasp the key link of endoscopic occupational safety, adjust measures to local conditions, reasonable planning, and maximize the maintenance of doctor-patient safety.

(2) Ventilation system: A scientific and reasonable ventilation system can effectively reduce the concentration of toxic and harmful gases such as glutaraldehyde in the air of the endoscopic working environment, and reduce the stimulation and damage to the respiratory system of doctors and patients. Good ventilation habits should be formed in all areas of the department, especially in the endoscope cleaning and disinfection room, the mechanical ventilation mode of "sending up and down" should be adopted; the safe storage of cleaning and disinfection solution should be strengthened, and local ventilation hood can be specially equipped above the container containing glutaraldehyde to ensure that harmful substances such as glutaraldehyde are discharged outside.

(3) The endoscope shall be cleaned and disinfected by automatic decontamination machine as much as possible. Compared with the traditional disinfection method, the disinfection process of the automatic decontamination machine is completely closed, automatically records the operating parameters, is convenient for quality control and is not affected by human factors. The specifications and guidelines of many countries, such as the Japanese Committee of Digestive Endoscopy Technicians, WGO and the American Association of Digestive Endoscopy, suggest that automatic endoscope flushing machines should be used as much as possible to avoid contact with cleaning disinfectants such as GA.

3. Protection of physical hazardous factors

Endoscopic medical staff should strictly abide by the operating specifications when performing various operations to avoid sharp instrument stab wounds. Advocate the use of safe indwelling needle, in order to reduce the occurrence of needle stick injury, with the syringe suction drug, should also try not to back the needle cap. In case of sharp instrument stab incident, it shall be handled in time according to the emergency plan. In addition, for medical personnel operating in a radiation environment, in addition to being equipped with radiation protection devices as required, personal radiation dose monitoring should be carried out regularly, and exposure to radiation should be rotated frequently to avoid accumulation of radiation in individuals.

4. Strengthen self-protection

(1) Strengthen on-the-job training and cultivate protection awareness. Due to the special nature of endoscopy work, medical personnel are faced with many occupational hazards. Only relying on the supervision and restraint of a few managers and rules and regulations can not achieve the goal of safe practice. Instead, it is necessary to mobilize the conscious action consciousness of all employees and jointly maintain it. The endoscopy department should regularly carry out academic lectures or hold training courses. On the basis of on-the-job training for all staff, it should focus on strengthening the business guidance and assessment of endoscopic decontamination personnel and key post operators, standardize the operation process, and implement the protection system [22], so that the post safety awareness can be accurately implemented and fully popularized.

(2) relieve work pressure and maintain physical and mental health. In recent years, with the development and progress of endoscopic technology, endoscopic diagnosis and treatment functions have been continuously increased, and the amount of endoscopic diagnosis and treatment has increased rapidly. Medical personnel engaged in endoscopic work face more work pressure and mental pressure than other departments [23], and physical and mental health problems occur from time to time. Therefore, relieving work pressure and maintaining the physical and mental health of employees have become problems that cannot be ignored in the safety management of endoscopic departments. Relevant departments should rationally allocate the proportion of medical staff according to the working characteristics of endoscopy departments, implement flexible shift scheduling system, pay attention to the physical and mental health of employees, help them master the methods of emotional management and pressure release, and maintain good working conditions.

3. Conclusion

With the rapid development and popularization of endoscopic diagnosis and treatment technology, we should pay attention to the occupational safety and protection of endoscopic medical personnel while taking patients as the center in clinic. However, it is still a long-term and systematic work to reduce and eliminate the occupational hazards of endoscopic medical staff. It is not only necessary to increase the capital investment of basic protective equipment, speed up the automation and modernization process of endoscopic decontamination, but also need relevant departments and managers to pay enough attention, need the self-protection awareness of endoscopic practitioners, and jointly build a standardized safety protection management system, so as to reduce the occurrence of occupational hazards, maintain the physical and mental health of endoscopy medical staff and better serve the patients.

Source:Chinese Journal of Digestive Endoscopy, No. 3, 2015, pp. 137-139


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