OCCUPATIONAL-HEALTH IN SURGERY - RISKS EXTEND BEYOND THE OPERATING-ROOM

Surgeons routinely work with potentially infectious materials. The ris k of acquiring a disease from one percutaneous exposure is 0.3-0.4% fo r human immunodeficiency virus (HIV) 6-30% for hepatitis B virus (HBV) and 2.7-10% for hepatitis C virus (HCV). Rates of blood contacts vary but may reach up to 11.9 per 100 h in the operating room. Residents a re at highest risk, and obstetrics and gynaecology surgeons suffered t he highest rate of exposures (10%) as a group. Contributing risk facto rs include trauma or emergency orthopaedic procedures, high patient bl ood loss, long procedures and holding tissue by hand while suturing. H owever, across occupations, nurses and other health workers experience greater risks than surgeons regarding potentially infectious exposure s. Preventive measures such as the HBV vaccine and protective devices (i.e. self-capping needles, needle-free i.v. systems and improved barr ier materials) have reduced the occupational risk of acquiring a blood -borne infection, which allows attention to be given to the psychosoci al risks which may be more significant, yet are often overlooked. Doct ors are at greater risk of divorce, alcoholism, substance abuse and su icide than are members of comparable professional groups. One study fo und that general surgeons had the highest rates of suicide of all doct ors. According to family surveys, surgeons tend to be oblivious to the effects of work stressors, and may benefit from greater self-awarenes s; sharing of feelings and responsibilities with colleagues, family an d patients; being willing to delegate work to others; setting work lim its; and broadening perspectives in their approach to work.