Female healthworkers need better radiation protection to minimise breast cancer risk
Standard PPE does not fully protect breast tissue; Employers should invest in equipment that ensures the safety of all their staff
Women working in healthcare who are regularly exposed to radiation from x-rays and other imaging procedures need better ionising radiation protection to help minimise their risk of developing breast cancer, argue doctors in The BMJ today.
Ionising radiation is a known human carcinogen and breast tissue is highly radiation sensitive. As such, there are concerns that regular exposure to ionising radiation during image guided procedures may be linked to a higher risk of breast cancer in female healthcare workers.
Personal protective equipment (PPE) such as lead gowns are used to shield the body from harmful radiation during these procedures. But studies have shown that current radiation PPE provides inadequate protection to breast tissue as it leaves the area close to the armpit (known as the upper outer quadrant and axilla - the most common site of breast cancer) exposed.
“Providing adequate breast covering PPE could therefore reduce radiation exposure and potentially help prevent breast cancer in female healthcare workers,” write Isobel Pilkington and colleagues.
They acknowledge that measuring the risk of occupational radiation induced breast cancer in women working in healthcare is challenging, but as the number of female trainees entering these specialties increases, they say “it is essential that the available evidence is considered and equipment provision improved to minimise this risk.”
They point to observational evidence suggesting an increase in breast cancer risk among female US orthopaedic surgeons compared with an age matched female population, and to a small Finnish study showing breast cancer at 1.7 times the expected rate in radiologists, surgeons, and cardiologists compared with female physicians not working with radiation.
In a study using artificial female torsos to measure radiation exposure, researchers found inadequate upper outer quadrant protection and no statistically significant reduction in dose when standard PPE was compared with a torso without PPE.
Occupational radiation exposure has not been identified as a risk factor for male breast cancer. However, the Ionising Radiation Regulations 2017 state that the radiation dose delivered to all workers should be As Low As Reasonably Achievable (ALARA). The most effective way to achieve this, say the authors, is by reducing the duration of exposure, increasing the distance from the source, and shielding all workers with effective PPE.
They point to additional protection, such as capped sleeves and axillary wings, that can be worn under standard gowns to protect the upper outer quadrant of the breast, and say the European Society for Vascular Surgery 2023 Clinical Practice Guidelines on Radiation Safety have already recommended female operators consider adopting this extra protection.
“Providing appropriate protection is a legal requirement of an employer, who has a duty of care to all workers exposed to radiation,” they write. “The female breast appears to be particularly vulnerable and it is therefore important employers invest in protective equipment that enhances the safety of all their staff.”
[Ends]
JOURNAL
The BMJ
METHOD OF RESEARCH
Commentary/editorial
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Protecting female healthworkers from ionising radiation at work
ARTICLE PUBLICATION DATE
12-Apr-2023
New study demonstrates hospital safety climate and organizational characteristics predict healthcare-associated infections and occupational health outcomes
Findings provide first published evidence of relationship between standard precaution adherence and safety of both healthcare workers and patients
Arlington, Va., April 13, 2023 – New data published today in the American Journal of Infection Control (AJIC) provide the first published evidence that a positive safety climate and adherence to standard precautions predict key healthcare-associated infection (HAI) and occupational health outcomes among patients and health care workers, respectively. The findings highlight features within hospitals’ organizations and safety climates that could be modified to improve these outcomes.
“Despite the infection prevention and safety benefits associated with standard precautions, generating consistent adherence in the healthcare setting has been notoriously challenging, for reasons that are not completely clear,” said Amanda J. Hessels, PhD, MPH, RN, Assistant Professor, Columbia University School of Nursing and Nurse Scientist at Hackensack Meridian Health and the lead author on the published study. “To our knowledge, our study findings are the first to demonstrate an association between adherence, hospitals’ patient-safety climates, and outcomes, and should help to advance the state of the science in patient and occupational health and safety.”
Annually approximately 385,000 sharps injuries occur among America’s 5.6 million healthcare workers, and approximately 2 million hospitalized patients acquire one or more HAIs after receiving healthcare. Standard precautions such as hand hygiene, use of appropriate personal protective equipment (PPE), and safe use and disposal of sharps, are federally regulated sets of actions designed to limit the risk of blood-borne and other infections among healthcare workers and prevent patient HAIs. Research shows that adherence to standard precautions happens less than 50% of the time.
Dr. Hessels and colleagues created a novel study to determine the relationships among patient safety climate, self-reported or observed standard precaution adherence, and HAIs or healthcare worker sharps and splash exposures.
The researchers surveyed 452 U.S.-based registered nurses about their hospital units’ patient safety climates, collected observational adherence data on 5,285 standard precautions using a standardized tool, and obtained corresponding unit-level data on patient HAIs and healthcare worker sharp and splash exposure data.
Results show:
- Overall adherence to all categories of standard precautions was 64.4%, with significant differences by provider role.
- Overall adherence was highest among nurses (69.1%), followed by other providers (62.1%) and physicians (58%).
- There is a positive correlation (p < 0.1) between patient safety climate in aggregate and reported standard precaution adherence.
- There is an additional, positive correlation between positive perceptions of a work environment that is conducive to standard precautions and reported adherence (p < 0.1).
Additionally, researchers found that a group of variables comprising observed standard precaution adherence, overall patient safety climate, and multiple potential confounders – including hospital Magnet status, level of nurse staffing, hospital ownership, and teaching status -- reliably predicted:
- The rates of catheter-associated urinary tract infections (CAUTI; p = 0.2) and methicillin-resistant Staphylococcus aureus (MRSA; p = 0.3) among patients.
- Nurse mucotaneous exposures (p = 0.004), all staff mucotaneous exposures (p = 0.007), and all staff sharps and needle injuries (p = .001).
Finally, researchers concluded that these variables also explained the sizeable variance in MRSA (41%), CAUTI (23%), mucotaneous exposures (43%), and needlestick and sharps injuries (38%) among those units that reported positive patient safety climates and reliable adherence to standard precautions vs. those that did not.
“Keeping our healthcare workforce and patients safe is our number one priority as healthcare professionals,” said Patricia Jackson, RN, MA, CIC, FAPIC, 2023 APIC president. “The findings from this study provide important insights into the factors that impact HAIs and occupational injuries and will help infection preventionists design focused strategies for improvement.”
About APIC
Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.
About AJIC
As the official peer-reviewed journal of APIC, The American Journal of Infection Control (AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at ajicjournal.org.
NOTE FOR EDITORS
“Impact of patient safety climate on infection prevention practices and healthcare worker and patient outcomes,” by Amanda J. Hessels, Jingwen Guo, Cara T. Johnson, and Elaine Larson, was published online in AJIC on April 13, 2023. The article may be found at: https://doi.org/10.1016/j.ajic.2023.01.021
AUTHORS
Amanda J. Hessels, PhD, MPH, RN, CIC, CPHQ, FAPIC, FAAN (corresponding author: ah3269@cumc.columbia.edu; amanda.hessels@hmhn.org), Columbia University School of Nursing, New York, New York, USA; Hackensack Meridian Health, Ann May Center, Neptune, NJ
Jingwen Guo, MS
Columbia University Data Science Institute, New York, New York, USA
Cara T. Johnson, RN, MPH
Columbia University School of Nursing, New York, New York, USA
Elaine Larson, RN, PhD, FAAN, CIC
Columbia University School of Nursing, New York, New York, USA
Acknowledgments: This project was supported by the Research Scientist Development Award Agreement Number, 1K01OH011186, funded by the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Its contents are solely the responsibility
of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
JOURNAL
American Journal of Infection Control
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Impact of patient safety climate on infection prevention practices and healthcare worker and patient outcomes
ARTICLE PUBLICATION DATE
13-Apr-2023
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