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Updated: Mar 18 2023

Occupational Health

Images radiation figure_moved.jpg
  • Radiation Exposure and Fluoroscopy
    • Factors which increase radiation exposure levels during use of fluoroscopy
      • standing closer to the c-arm emitter
      • imaging large body parts
      • positioning extremity closer to the x-ray source
      • use of large c-arm rather than mini c-arm
        • radiation exposure is minimal during routine use of mini-c-arm fluoroscopy unless the surgical team is in the direct path of the radiation beam
    • Factors to decrease radiation exposure to patient and surgeon
      • maximizing the distance between the surgeon and the radiation beam
      • minimizing exposure time
      • manipulating the x-ray beam with collimation
      • orienting the fluoroscopic beam in an inverted position relative to the patient
      • strategic positioning of the surgeon within the operative field to avoid direct path of beam
      • use of protective shielding during imaging
  • Risk of Transmission
    • Risk of HIV transmission
      • needlestick
        • seroconversion from a contaminated needlestick is ~ 0.3%
          • exposure to large quantities of blood increases risk
        • seroconversion from exposure to HIV contaminated mucous membranes is ~0.09%
      • frozen bone allograft
        • risk of transmission is <1 per million
          • donor screening is the most important factor in prevention
          • no reported cases of transmission from frozen bone allograft since 2001
      • blood transfusion
        • risk of transmission from blood transfusion is 1/500,000 per unit transfused
        • seronegative blood may still transmit virus due to delay between HIV infection and antibody development
    • Risk of Hepatitis B transmission
      • needlestick
        • 37% to 62% eventually seroconvert following needlestick
        • 22 to 31% develop clinical Hepatitis B infection following needlestick
    • Risk of Hepatitis C transmission
      • needlestick
        • 0.5 to 1.8% risk of transmission
  • Resident Surgeon Work Duty Hours
    • ACGME has restricted work hours in order to address impaired performance by residents caused by long duty hours
    • Duty hours
      • include
        • clinical time
        • academic hours
        • administrative work
        • time on call
          • no more than 1 day per every 3 days in house
          • must include a 10-hour period of "off-time" between
            • clinics
            • on-call
      • restricted to 80 or less per week (averaged over a 4 week period)
      • 10% increase allowed if justified by educational value
      • 1 day in 7 must be a day off (averaged over 4 week period)
    • Results of new duty hours
      • early evaluations have caused concern over issues of
        • patient safety
        • continuity of care
          • communication and transfers in care have been cited as sources of decreased continuity of care as a sequelae of the 80-hour resident physician work week
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