The Risky Business of Nursing

Radiation

Radiation exposure may be the most insidious hazard in healthcare. It's invisible and odorless. You can't be sure whether you have not been exposed, so what is there to report? The effects may become apparent long after years of cumulative exposure, and impossible to connect with an occupational injury.

Radioactive materials and ionizing radiation have many diagnostic and therapeutic uses in patient care. Sources of radiation exposure include holding patients for portable radiography or fluoroscopy procedures and taking care of patients who are undergoing nuclear medicine therapy, such as brachytherapy. Nurses spend more time in close contact with patients than any other healthcare worker, so when radiation is present, nurses are likely to be exposed. Working around ionizing radiation requires nurses to be constantly vigilant and stringently follow established safety procedures. Badge and ring dosimeters are available for long-term monitoring of radiation exposure.

Typically, nurses who regularly work nearby sources of radiation are trained in radiation safety. However, some nurses may not be aware of the extent of their exposure to radiation. For example, neonatal intensive care nurses often hold babies still during portable radiograph acquisition in the neonatal intensive care unit. A recent study^[18] that evaluated the radiography films of neonates for the presence of adult fingers found that of 230 radiographs audited, 30 (13%) contained adult fingers directly in the x-ray beam, representing a significant source of occupational exposure for these neonatal nurses.

The possible effects of radiation exposure can be acute (eg, erythema, dermatitis, nausea, vomiting, diarrhea, weakness, death) or chronic (skin cancer, bone marrow suppression, congenital defects in offspring).

Nonionizing radiation (laser) is also used in healthcare. A laser produces an intense, highly directional beam of light and has many different applications. The most common hazard associated with laser beams is thermal injury to the skin or eyes.

During electrosurgical procedures with a laser, the thermal destruction of tissue produces smoke (a "surgical plume") that can pose an inhalation danger to surgeons, nurses, anesthesiologists, and other staff. The surgical plume contains toxic gases, such as carbon monoxide, polyaromatic hydrocarbons, and other gases, the inhalation of which are associated with upper respiratory irritation and mutagenic effects.^[19] Although the actual health risks of inhaling surgical plume have yet to be quantified, studies have found viable cellular, bacterial, and viral material in plume.^[20] Smoke evacuators are recommended for the control of surgical plume.

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Cite this: The Risky Business of Nursing - Medscape - Jan 14, 2014.