University of Alabama at Birmingham, Birmingham, Alabama.
Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York.
J Bone Joint Surg Am. 2018 Feb 7;100(3):e16. doi: 10.2106/JBJS.17.00604.
Excessive radiation to health-care providers has been linked to risks of cancer and cataracts, but its negative effects can be substantially reduced by lead aprons, thyroid shields, and leaded glasses. Hospitals are required to provide education and proper personal protective equipment, yet discrepancies exist between recommendations and compliance. This article presents the results of a survey of U.S. orthopaedic surgery residents concerning attitudes toward radiation exposure and personal protective equipment behavior.
An invitation to participate in a web-based, anonymous survey was distributed to 46 U.S. allopathic orthopaedic surgery residency programs (1,207 potential resident respondents). The survey was conceptually divided into the following areas: demographic characteristics, training and attitudes concerning occupational hazards, personal protective equipment provision and use, and general safety knowledge. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated for the association between these characteristics and compliance with thyroid shield or lead gown wear.
In this study, 518 surveys were received, with 1 survey excluded because of insufficient response, leaving 517 surveys for analysis (42.8% response rate). Ninety-eight percent of residents believed that personal protective equipment should be provided by the hospital or residency program. However, provision of personal protective equipment was not universal, with 33.8% reporting none and 54.2% reporting provision of a gown and thyroid shield. The prevalence of leaded glasses usage was 21%. Poor lead gown compliance and thyroid shield wear were associated with difficulty finding the corresponding equipment: PR, 2.51 (95% CI, 1.75 to 3.62; p < 0.001) for poor lead gown compliance and PR, 2.14 (95% CI, 1.46 to 3.16; p < 0.0001) for poor thyroid shield wear. Not being provided with personal protective equipment was also significantly associated with low compliance with both lead gowns (PR, 1.47 [95% CI, 1.04 to 2.08]; p = 0.03) and thyroid shields (PR, 1.69 [95% CI, 1.18 to 2.41]; p = 0.004). Respondents from the Southeast, West, or Midwest had lower compliance with lead gown usage. Forgetting was the number 1 reason to not wear a lead apron (42%).
Radiation exposure is associated with increased risk of serious health problems. Our findings identified that the availability of lead personal protective equipment leads to increased compliance among residents surveyed. In addition to yearly occupational hazard training specific to orthopaedic surgery, greater efforts by residency programs and hospitals are needed to improve access to lead personal protective equipment and compliance for orthopaedic residents.
过度的辐射会对医护人员的健康造成危害，增加患癌症和白内障的风险，但通过使用铅围裙、甲状腺屏蔽和铅玻璃等防护设备，可以大大降低辐射的负面影响。医院有责任提供教育和适当的个人防护设备，但建议与遵守之间存在差异。本文介绍了一项针对美国骨科手术住院医师对辐射暴露和个人防护设备使用态度的调查结果。
向 46 个美国骨科全科学术住院医师培训项目（1207 名潜在住院医师受访者）发送了参与在线匿名调查的邀请。该调查在概念上分为以下几个方面：人口统计学特征、职业危害相关培训和态度、个人防护设备的提供和使用以及一般安全知识。使用患病率比（PR）和 95%置信区间（CI）计算这些特征与甲状腺屏蔽或铅衣佩戴依从性之间的关联。
本研究共收到 518 份调查，因回复不充分排除 1 份调查，最终分析了 517 份调查（回复率为 42.8%）。98%的住院医师认为医院或住院医师培训项目应提供个人防护设备。然而，并非所有医院都提供个人防护设备，33.8%的医院报告没有提供，54.2%的医院报告提供了铅衣和甲状腺屏蔽。铅玻璃眼镜的使用率为 21%。铅衣和甲状腺屏蔽佩戴不佳与难以找到相应设备有关：铅衣佩戴不佳的 PR 为 2.51（95%CI，1.75 至 3.62；p<0.001），甲状腺屏蔽佩戴不佳的 PR 为 2.14（95%CI，1.46 至 3.16；p<0.0001）。未提供个人防护设备也与铅衣（PR，1.47[95%CI，1.04 至 2.08]；p=0.03）和甲状腺屏蔽（PR，1.69[95%CI，1.18 至 2.41]；p=0.004）佩戴依从性低显著相关。来自东南部、西部或中西部的受访者对铅衣使用的依从性较低。忘记是不穿铅围裙的首要原因（42%）。
辐射暴露与严重健康问题的风险增加有关。我们的研究结果表明，提供铅质个人防护设备可提高被调查住院医师的依从性。除了针对骨科手术的年度职业危害培训外，住院医师培训项目和医院还需要加大努力，改善骨科住院医师获得铅质个人防护设备和遵守规定的机会。
