The tremendous growth of fluoroscopy in the emergency room, as well as during orthopedic, coronary and vascular procedures, has dramatically increased the occupational risk of radiation exposure for surgeons and other healthcare personnel. Since radiation exposure is cumulative over a person’s lifetime and the effects are permanent, protecting clinicians against occupational exposure is a top priority for healthcare organizations.
For those who work in healthcare — particularly surgeons — the hands are among the most vulnerable parts of the body subjected to radiation exposure, yet workers’ hands are often among the most under-protected body parts.
Becker’s Hospital Review recently spoke with clinical experts at Ansell about the importance of protecting clinicians’ hands by using proper PPE products that conform to best practice guidelines by AORN, Association of Surgical Technologists (AST), Nuclear Regulatory Commission (NRC) and others.
Medical innovation in radiology means healthcare professionals often face higher levels of radiation exposure
During surgical procedures, surgeons and other staff are often subjected to ionizing radiation. This produces a high amount of energy that is absorbed by the tissue and leads to the formation of free radicals, inhibition of cell mitosis, nucleus damage and more.
In recent decades, a wide range of medical professionals from various specialties have experienced an increased risk of cancer. They also have experienced other biological effects such as development of cataracts, alteration of thyroid function and neurogenerative disorders.
A variety of medical procedures generate the risk of radiation exposure. The level of exposure and risk depends, however, on the surgical techniques used. Radiation is used most commonly in orthopedic and spinal surgeries. To ensure accurate placement of instrumentation, for example, clinicians use intraoperative radiographic images to guide and confirm the location of implants.
Minimally invasive surgeries have also led to an increase in fluoroscopy. “These procedures have multiple benefits, such as reduced operative time and lower levels of morbidity. The drawback, however, is an increased risk of radiation exposure to surgeons, patients and staff,” explained the Ansell clinical team.
Radiation exposure is a concern due to its potential ability to produce biological effects. Any amount of exposure to ionizing radiation that leads to secondary occupational risk should be avoided or maximum caution should be exercised to minimize the exposure.
Many PPE solutions fail to protect clinicians from radiation
When it comes to radiation exposure, clinical evidence suggests that the hands are the most vulnerable part of a surgeon’s body. A 2015 study on occupational radiation exposure on C-arm fluoroscopy during common orthopedic procedures found a significant positive correlation between the exposure time and exposure dose for the right wrist and left wrist. The dominant hand had the maximum exposure overall.
This can be correlated to increased exposure of the surgeon’s dominant hand which is closer to the image intensifier during procedures and thus is in closer proximity to the radiation.
Traditional intraoperative fluoroscopy protection typically relies on thyroid shields and aprons. Yet, surgeons’ eyes and hands often receive more exposure than previously appreciated and they are often the least protected parts of the body. Research by Hoffler, et al., found that hands showed statistical significance, with exposure averaging 13 times higher than other recorded exposures. Eye exposure averaged 2.2 times higher than the mean exposure for the thyroid, chest or groin areas.
For hand protection, using standard sterile surgical gloves or double gloving provides clinicians with a false sense of security. In reality, these practices provide only 1 percent radiation protection. Radiation-attenuating surgical gloves are a simple and more effective solution for reducing radiation exposure, especially for procedures that require greater fluoroscopy use. The study conducted by Hoffler, et al., found that this type of glove reduced hand radiation exposure by nearly 70 percent.
Although most operating surgeons worry about radiation exposure, radiological protection measures in clinical practice are still poorly understood and their practical implementation is insufficient. More education is needed to promote better radiation protection.
Healthcare organizations must adopt a radiation protection culture to protect employees
In the United States, the Nuclear Regulatory Commission regulates exposure to radioactive materials and OSHA requires employers to protect workers from ionizing radiation sources that aren’t regulated by the NRC or other federal agencies. X-ray equipment, for example, falls under OSHA’s jurisdiction.
Under OSHA’s Ionizing Radiation standard (29 CFR 1910.1096), employers must ensure that occupational dose limits aren’t exceeded and must survey radiation hazards to comply with the standards, supply appropriate personal monitoring like dosimeters, post caution signs and labels and provide instruction to personnel and post-operating procedures.
“By establishing a radiation protection culture, or RPC, healthcare organizations can promote a better understanding of radiation exposure risks and prevent unnecessary radiation exposure among staff and patients alike,” said the Ansell team.
The International Commission on Radiological Protection introduced the concept of a radiation protection safety culture in 2016. To cultivate this type of culture, healthcare professionals and staff must adopt a combination of beliefs, practices and rules regarding radiation protection. In most cases, the greatest challenge is improving radiation protection, rather than building a new standard of practice.
“A radiation protection culture is driven from the highest levels in the organization and promoted in every unit. It requires continuing education for employees, effective communication among stakeholders at all levels and quality assurance programs,” explained the Ansell team.
The benefits of an RPC include reduced radiation doses, enhanced radiation risk awareness, fewer unsafe practices and higher-quality radiation protection programs.
Innovative PPE is an integral part of a strong radiation protection culture
An important component of a radiation protection culture is a commitment to using appropriate PPE, such as lightweight aprons and radiation protection gloves. Dedicated radiation attenuation gloves offset the risk of scattered radiation exposure during fluoroscopy and catheterization labs.
“Ansell’s radiation attenuation gloves, or RAGs, represent the next generation in this important form of PPE. Unlike lead mittens and lead-lined gloves, Ansell RAGs are made of bismuth oxide and/or tungsten. As a result, healthcare organizations can dispose of them safely and they pose no toxicological or environmental risks,” explained the Ansell team.
Ansell has developed both latex and latex-free radiation attenuation gloves. These include ENCORE® Latex Radiation Attenuation products and GAMMEX® PI Radiation Attenuation products. Ansell’s RAGs offer higher tactile sensitivity than traditional PPE, as well as superior elongation and comfort. The new version of the GAMMEX PI Radiation gloves include the proprietary PI KARE skin- friendly technology which utilizes less accelerators than other competitor offerings to address glove-induced allergy concerns. Ansell’s RAGs also attenuate up to 69 percent of scattered radiation without compromising dexterity, which occurring when using more antiquated lead mittens.
“PPE plays a central role in a strong radiation protection culture. At Ansell, we’re dedicated to delivering optimized solutions that provide a high degree of confidence to clinicians seeking protection with a high level of dexterity, comfort and grip so they can perform at their best. Healthcare workers around the world entrust their hands to ours,” said the Ansell team.
This article was sponsored by Ansell.