Respiratory therapists may assume some of the highest
rates of exposure to occupational injury.
Is health care hazardous to your
health? The professions dedicated to the care of people
suffering from sickness and injury have always assumed a risk,
and those risks are often taken for granted. Hospitals are
oriented toward treating disease, rather than maintaining
health, and are thereby often part of the problem. In spite of
diligent efforts to consistently practice infection control
and on-the-job safety, respiratory therapists may assume some
of the highest rates of exposure to occupational injury.
According to the National Institute for Occupational Safety
and Health (NIOSH), “Health care workers face a wide range of
hazards on the job, including needle stick injuries, back
injuries, latex allergy, violence, and stress.”1
Respiratory therapists have additional exposures from
infectious diseases and toxic chemicals and potential
radiation exposure. While acknowledging that it is impossible
to eliminate these risks, NIOSH notes that health care workers
are experiencing increasing numbers of occupational injuries
and illnesses that have continued to rise over the past
decade. Meanwhile, two of the most hazardous
industries—agriculture and construction—are safer today than
they were a decade ago.
Needlesticks may be
the first issue to come to mind when considering occupational
safety risks to respiratory therapists, as they are the most
frequent source of transmission of blood-borne disease in
health care workers.2 While airborne pathogens and
stress can be just as sinister, exposure to blood-borne
pathogens, especially from needlesticks, is unique in that the
exact moment and circumstances of exposure are self-evident.
The risk of exposure varies according to the type of exposure
(needlestick, eye, mouth, or skin contact), the type of
pathogen (ie, HIV, hepatitis B or C), the amount of blood, and
the amount of the pathogen in the patient’s blood at the time
Fortunately, a fundamental change has taken place in both
the tools we use and the way we use them. “Cap-less” syringes
give us better tools. Readily available sharps containers and
gloves, improved education of staff, and strict enforcement of
infection control policy do not minimize the frequency of
exposure to potential incidents, but they dramatically reduce
adverse incidents and outcomes.
Even “foolproof” tools and consistent training can be
foiled in a thoughtless moment, however. I recently observed a
colleague draw an arterial blood gas, and withdraw the needle
from the patient. Feeling a bit awkward holding the syringe in
her left (subdominant) hand, she nearly used her forearm as a
“hard surface” to close the protective sheath over the needle!
In an instant, she realized the mistake and found an
appropriate surface to leverage the cover closed. Respiratory
therapists make these split-second decisions thousands of
times each day, and the wrong move occasionally results in an
There are an average of 1,000 sharps injuries per
day.3 These are only the exposures that are
reported—surveys of health care workers suggest that half or
more of health care personnel do not report their needlestick
injuries. Experience has shown that workers do not effectively
change their behavior unless they believe the risk is
occupational hazards confront most patient care providers,
including back strains and latex allergies, others are of
special concern for respiratory therapists. Some experts now
describe the health care environment as a chemical soup—a
complex mixture of medicines and sterilization agents that
circulate in the air and are recycled through the heating,
ventilation, and air-conditioning systems.4
Inhalation of respiratory drugs and infectious diseases
poses a variable risk depending on the nature of the
pharmaceutical or pathogen involved. Asthma can also result
from exposure to common chemicals, including latex proteins
and sterilizing and fixative agents such as glutaraldehyde,
formaldehyde, and ethylene oxide.4 Some aerosolized
medications, including pentamidine, methacholine, and
ribavirin, require specialized aerosol generators with one-way
valves and filters to prevent environmental contamination and
to protect the RT administering the drug.5 RTs who
have asthma should not be exposed to drugs used in asthma
challenge testing, and therefore may need to be excluded from
performing the tests. Due to rigorous FDA testing and
regulation, special handling of respiratory drugs is clearly
specified, but it is up to the institution and the individual
to heed the warnings.
In addition to inhaling potentially harmful drugs, RTs face
the constant onslaught of bacterial and viral infections to
which our work necessarily exposes us. Sudden acute
respiratory syndrome (SARS), cytomegalovirus (CMV), and
tuberculosis get the most press, but much more common
nosocomial respiratory infections probably present a more real
threat to our health, causing untold loss of work days. We can
substantially protect ourselves by diligent hand washing and
use of protective masks.
Stress may the most ubiquitous,
yet ignored risk posed to health care workers. Long hours,
interrupted meal breaks, night shifts, overtime, monitor
alarms, irritability of overworked coworkers, and the constant
stress of dealing with critically ill patients take a toll in
both the immediate and long term. When rescuers, including
police and firemen, are exposed to massively stressful
situations, the potential for post-traumatic stress disorder
is recognized, and rescuers may consequently be provided with
or even required to receive counseling. But the cumulative
effects of day-to-day stress in a modern hospital setting are
just beginning to be understood.
The atmosphere in hospitals was at one time serene, and
street signs admonished people to be quiet in a so-called
“hospital zone.” Nowadays, the atmosphere outside a hospital
may be just as frenzied as it has become inside—jackhammers
and bulldozers turn the campus into a construction site as
harried visitors and employees vie with one another for
In an essay in The New England Journal of
Medicine, Dr Gerald Grumet laments the fundamental change
in the hospital as a workplace: “That subdued setting has
gradually been replaced by one of turbulence and frenzied
activity. People now dart about in a race against time;
telephones ring loudly, intercom systems blare out abrupt,
high-decibel messages that startle the unsuspecting listener.
These sounds are superimposed on to a collection of beeps and
whines from an assortment of electronic gadgets—pocket pagers,
call buttons, telemetric monitoring systems, electronic IV
machines, ventilator alarms, patient activity monitors, and
computer printers. The hospital, designed as a place of
healing and tranquility for patients and of scholarly
exchanges among physicians, has become a place of beeping,
buzzing, banging, clanging, and shouting.”6 EPA
noise guidelines for hospitals of 45 dB at day and 35 dB at
night are routinely exceeded.
All this takes a toll on workers, and administrators trying
to understand and address the causes of “burnout” need only
spend a day looking at and listening to the onslaught of
stress and fight-or-flight stimuli a staff therapist endures
over a 12-hour shift. RTs wade through the previously
described chemical soup of recirculated air, bathed in
fluorescent light, and often fueled by caffeine or nicotine to
keep them going. A cigarette break is often the closest they
come to fresh air and sunshine for a period of days. Some RTs
have told me that they continue smoking because it guarantees
them a break from the chaos of back-to-back emergencies and
critical care patient transports.
Administrators of neonatal intensive care units (NICUs)
have begun to heed the numerous studies that document the
deleterious effects of noise on newborns. Noise levels have
conscientiously been lowered, and environmental noise levels
can be monitored to document compliance. Their patients have
benefited, requiring significantly fewer days of respiratory
support on a ventilator and fewer days of oxygen
In April 2004, the Department of Health and Human Services
issued the Summary of Recent Findings on Illnesses, Injuries,
and Health Behaviors9 that has alarming
implications for respiratory therapists. Overtime was
associated with poorer perceived general health, increased
injury rates, unhealthy eating habits, weight gain, and
increased alcohol use. Increased smoking, illnesses, even
increased mortality, and poorer neuropsychological test
performance were also noted, especially where 12-hour shifts
were combined with 40+ hours of work per week. Nurses working
nights or extended rotating shifts were at increased risk for
alcohol use and smoking. And as health care workers increased
their hours, automobile crashes and on-the-job accidents
Numerous studies published in The New England Journal of
Medicine10-13 address the issue of fatigue among
clinicians, and its impact on patient safety. Interestingly,
when we can show that long hours and stress impact patient
health and safety, there is a prompt commitment to resolve the
problem. But when the impact is on employee health and safety,
changes seem to come more slowly. “Other industries have not
waited for absolute proof of risk due to operator fatigue. In
the transportation industry, federal regulations limit work
and duty hours.”6 A relatively new and welcome
movement is mandating limits on the number of hours medical
residents can be expected to work. This fundamental change in
the culture of health care organizations is overdue—staff
exhaustion is beginning to be viewed as a problem that needs
correcting, rather than as a sign of dedication.
Whether from the relatively obvious risks posed by
needlesticks, the invisible risks of inhaled chemicals and
infectious diseases, or the persistent strain of long hours
and stressful environment, health care professions are
potentially harmful to the health of the workers. The good
news is that a commitment to worker health and safety has
effectively minimized blood-borne and respiratory exposure.
Our NICUs are leading the way toward a safer and saner working
environment. By understanding and acknowledging the risks, we
can take the necessary steps to eliminate or at least manage
the potential damage. We need only admit we have a problem,
and begin to agree on solutions.
John A. Wolfe is a respiratory therapist in Fort
Collins, Colo, and is a member of RT's editorial
1. National Institute for
Occupational Safety and Health. NIOSH Safety and Health Topic:
Health Care Workers. Available at:
2. AARC Clinical
Practice Guidelines. Sampling for arterial blood gas analysis.
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