[Working in the Operating Theatre - What does the Surgeon Need to Know About Occupational Medicine?] / Arbeitsplatz OP-Saal ­ Was muss der Chirurg über die Arbeitsmedizin wissen?

Surgery is associated with numerous health hazards for the staff.The aim of this article is to show the risks to the health and ability to work of surgical staff and the possibilities for improving occupational health and safety in terms of behavioural and situational prevention, as well as secondary and tertiary prevention, especially with regard to cooperation with the occupational physician.The brief narrative overview is based on the author's own occupational medicine, surgery and interdisciplinary experience from daily practice and selective references from the current medical-scientific literature, using the example of the operating theatre work area.The possible activity-related health hazards and the risks to the working ability of medical staff as well as the possibilities for occupational health and safety in the sense of behavioural and situational prevention are an important matter in the interdisciplinary status of surgery that should not be underestimated (since it is also partly determined by law). Above all, this discipline must responsibly dedicate itself to the points of contact with occupational medicine (in addition to acquiring its own knowledge from the surgical side).

24 h-Heart Rate Variability as a Communication Tool for a Personalized Psychosomatic Consultation in Occupational Health.

New tools for non-specific primary prevention strategies covering somatic and mental health in occupational medicine are urgently needed. Heart rate variability (HRV) reflects the capacity of the body to adapt to environmental challenges and of the mind to regulate emotions. Hence, a 24 h-measurement of HRV offers a unique possibility to quantify the interaction between situation-specific emotional regulation within a specific psychosocial environment and physiological state, thereby increasing self-perception and inducing motivation to change behavior. The focus of the present study represents such a 24 h-measurement of HRV and its presentation as a comprehensive graph including protocol situations of the client. A special training program for occupational health physicians and questionnaires for clients were developed and administered. The article reports the first data of the study "healthy leadership and work - body signals for managers and employees", an investigator-initiated, interventional, single-arm, open (non-blinded), multicenter, national trial with 168 participants. They reported a significantly improved perception of their bodily needs after the consultation (from Median = 7, interquartile range 5-8 to Median = 8, interquartile range 7-9; scale range from 1 to 10; p < 0.001, Wilcoxon rank test; effect size 0.49). The 16 occupational health physicians stated that the measurement of HRV was very well suited to enter into dialog with the managers and was feasible to show interactions between situations, thoughts, feelings, and bodily reactions. Taken together, we show that a 24 h-HRV-measurement can be a feasible and effective approach for holistic, psychosomatic primary prevention in occupational medicine. We discuss possible mechanisms for improving the individual health via the consultation, containing mindset and improved ANS activity.

[Hygienic Inspections of Ventilation Systems Under Resting Conditions (According to DIN 1946-4:1999-03) - A Retrospective Assessment]. / Hygienische Abnahmeprüfungen raumlufttechnischer Anlagen unter Ruhebedingungen nach DIN 1946-4:1999-03 ­ eine retrospektive Auswertung.

BACKGROUND: Hygienic and microbiologically sterile air quality is essential for successful guideline-based work in operating theatres. To ensure clean air and to reduce contamination during surgery, ventilation systems are indispensable. Ventilation systems should be especially designed to keep the number of particles and germs under statutory limits. Therefore, they must be operated to recognised standards of good practice and be periodically inspected and maintained. The objective of this study was to prove, through the analysis of observation outside surgery time (rest condition), the effects of ventilation systems on air quality in a medical facility. METHODS: Measurements were taken in 34 operating theatres annually over a period of ten years outside surgery time (resting condition) but with the air ventilation system operating under full load. 29 operating theatres were provided with laminar air flow and five theatres with turbulent air flow systems. In each operating theatre, air cleanliness was analysed by measuring the amount of airborne particles and airborne germs. Measuring points were determined 10 mm beneath the supply-air ceiling in the centre of the operating theatre and at one position outside the supply-air ceiling. RESULTS: The number of airborne particles at the supply-air ceiling was between 0/m³ and 4,441/m³ of air and, as such, the limiting factor was never exceeded. However, airborne germ measurements of between 0 CFU/m³ and 200 CFU/m³ (CFU: colony forming units) demonstrated that the limiting factor for this criterion was exceeded in 10.9% of occasions. In general, the values in the middle of the room were higher than at the supply-air ceiling. There were significant differences (p < 0.001) between the values at the supply-air ceiling, the surgery table and the values outside the supply-air ceiling. CONCLUSIONS: The results show the positive impact of ventilation systems on the air cleanliness in operating theatres. However, laminar airflow systems seem to create cleaner air than conventional ventilation systems. The size of the supply-air ceiling plays an important role in the prevention of the contamination of the staff, the surgical field, the instrument table and the patient. However, the effect on surgical site infections has not been verified. Improved measuring methods should be considered.

Nicotine, cigarette smoking and cardiac arrhythmia: an overview.

Tobacco smoke is the single most important modifiable risk factor for coronary diseases and the leading preventable cause of death in the US. While the effect of cigarette smoking on the progression of atherosclerotic diseases is established and well studied, the role of cigarette smoking on cardiac arrhythmia is less clearly defined. In fact the pathophysiological mechanism of cigarette smoking-induced cardiac arrhythmia is very likely a complex one where the pro-fibrotic effect of nicotine on myocardial tissue with consequent increased susceptibility to catecholamine might play a role. Moreover, other constituents of cigarette smoking, such as carbon monoxide and oxidative stress, are likely to contribute to the generation of arrhythmias. Finally, cigarette smoking may induce coronary artery disease and chronic obstructive pulmonary disease, which also might cause arrhythmia independently. The objective of this paper is to summarize the published studies relating to cardiac arrhythmia induced by cigarette smoking, and to identify a pathophysiological mechanism by which cigarette smoking might induce cardiac arrhythmia.

Influence of occupational exposure to organic solvent mixtures on contrast sensitivity in printers.

Contrast sensitivity measurement accurately evaluates the sensitivity of all human visual channels, even in a more detailed manner than simple acuity measures can. This is a study of visual contrast sensitivity in a series of subjects occupationally exposed to organic solvents. Contrast sensitivity was measured for 42 printers and 28 age-stratified controls using the Vistech VCTS 6500 chart. The exposed workers distinguished between following three groups of printers: "low exposed," "middle exposed," and "high exposed." Abnormal contrast sensitivity results were recorded for the right eye in 38% of the printers and 11% of the controls and for the left eye in 38% of the printers and 7% of the controls. Especially, we found a reduced contrast sensitivity in all three groups exposed to solvents for both eyes. We conclude that contrast sensitivity is abnormal in workers exposed to organic solvents. The reduced contrast sensitivity in printers seems to be an indicator of visual defects induced in response to organic solvents exposure.