Occupational Hazards

WHAT DO PATHOLOGISTS SAY ABOUT WORKPLACE SAFETY?

Two surveys of occupational health concerns of pathologists were carried out in Switzerland in 2012 and in France in 2020 ( Table 6.1 ). ^, The most common reported were the same problems experienced by many white-collar workers, consisting of visual problems, musculoskeletal symptoms, and health risks associated with a sedentary lifestyle. The most frequent pathology-specific hazards were injuries from blades and irritation from chemicals. Infections were rare, and the surveys did not determine if they were occupationally related. Psychological issues were reported by some, but the incidence was similar to the general population and other physicians. In general, the majority of pathologists are satisfied with their job and experience lower rates of burnout and depression than other specialties.

Each of the health concerns reported by pathologists and possible ways to address them will be discussed.

Visual Problems

The most common health concern reported by pathologists was related to their vision. Some problems are not directly related to pathology because >80% of respondents reported having sight-related problems prior to becoming a pathologist in one of the surveys. However, in both surveys about half of pathologists reported that their vision had become worse over the course of their career. Suboptimal vision due to myopia (“farsightedness” or the difficulty of seeing objects at a distance) and presbyopia (age-­related changes in the lens resulting in difficulty seeing close-up objects) are more common in people engaging in extensive “near work.” The long hours looking through a microscope or at a computer screen may be a factor in diminishing visual acuity.

Unfortunately, there are not easy solutions. Pathologists can ensure that their microscope is frequently serviced and cleaned. Fewer hours at the microscope can help, but this is not an option for most pathologists. More practical is taking frequent breaks to rest one’s eyes. The increasing use of digital microscopy offers both the danger of possibly increasing eye stain, but also the potential to look for new and creative solutions to reduce it.

Musculoskeletal Problems

Many pathologists report back, neck, and arm pain due to working in a nonoptimal ergonomic environment. ^, Hunching over a microscope or a computer (“tech-neck”) is a common problem. Sitting for long hours can also increase overall and cardiovascular mortality. Surveys report that many pathologists are not aware of how to address these issues. ^,

Fortunately, there are many ways to prevent or minimize musculoskeletal problems. For example, improved adjustable seating and ergonomically designed microscopes allow the head to stay in a neutral position. Recommendations for avoiding injuries have been made by the Occupational Safety and Health Association, the Centers for Disease Control (CDC), and others ( https://www.osha.gov/sites/default/files/publications/OSHAfactsheet-laboratory-safety-ergonomics.pdf ; accessed June 14, 2021; Table 6.2 ).

It is better to have a work station evaluated by an ergonomic specialist before injuries have been sustained. The majority of large institutions have experts available.

Injuries And Mucosal Exposures

Injuries can result from blades and needles as well as from mucosal exposures to blood or other fluids during the examination of specimens and at autopsy. These injuries are most commonly reported earlier in careers due to more time spent doing these activities and having less experience during early training. Injuries also increase the risk of infections, which will be discussed later.

The most common type of injury is from a blade to the nondominant hand while sectioning a specimen. Injuries also occur when using a blade without a handle or when removing a blade from a handle. Metal mesh and Kevlar cloth type gloves worn under latex or nitrile gloves can help prevent puncture injuries, but are used by a minority of pathology personnel.

Needle-stick injuries occur, especially when performing fine-needle aspirations. Good technique in disposing of needles without recapping or special safety needles reduce the chance of injury. In general, needles should be avoided when another type of tool can be used.

An important rule for pathology personnel to follow is that the person who uses a sharp tool (blade or needle) must take the responsibility for disposing of it or placing it in a safe location. Very serious injuries can occur to an unsuspecting person during cleanup when a sharp object is hidden beneath paper towels or other debris.

Mucosal exposures can be avoided by using eye protection when handling any specimen that could result in a splash or aerosol exposure. For example, fluid-filled cystic masses can feel quite solid and result in a large gush of fluid when incised with a blade. The fluid is under pressure and can travel several feet when the cyst is opened (this has been documented by many pathologists!). The specimen should be placed near a sink on a surgical drape or blue barrier. While wearing eye protection, a small nick near the bottom of the mass will let the fluid slowly drain out of the cyst.

Chemical Exposures and Radiation

Pathology departments require the use of fixatives (most commonly formalin) as well as numerous other chemicals used in the processing of specimens. Skin contact or inhalation can result in injury.

Air quality needs to be monitored by the institution to ensure only appropriately low levels of fumes are present. Proper ventilation and the use of hoods are necessary to reduce exposure to noxious chemicals and are effective in limiting exposure. ^,

The simple practice of making sure all formalin containers are covered can reduce exposure.

Personal protective equipment must be used to protect the skin. Gloves should always be worn when handling fresh and fixed tissues. Latex gloves protect against biohazards but not fixatives. Some individuals (5–10%) have or develop allergic reactions (usually dermatitis but sometimes asthma or anaphylaxis) to latex antigens. Nitrile gloves provide protection from both biohazards and fixatives.

Radioactive substances are widely used in the evaluation of patients and may be present in tissues submitted to pathology departments. In some cases patients will have been injected with radioactive agents for the purpose of localizing and surgically removing a lesion (e.g., sentinel nodes or octreotide positive lesions). In general, patients are injected with small amounts (<5 millicuries), and typical half-lives are short (e.g., the half-life of ^99m technetium used for sentinel lymph nodes is 6 hours). Specimens should have minimal residual radioactivity and can be generally handled and disposed without special precautions. However, radiation safety personnel should be consulted to determine the appropriate procedures for the techniques used in individual institutions.

Infectious Disease

Occupational transmission to healthcare workers of hepatitis A, B, and C, tuberculosis (TB), human immunodeficiency virus (HIV), syphilis, Creutzfeldt–Jakob disease (CJD), Coccidiodes immitis , parvovirus, Helicobacter pylori , Cryptosporidium, scabies, Pertussis, and Brucella has been documented. During the recent COVID-19 pandemic, coworkers also became an occupational risk for exposure.

The incidence of transmission of infectious agents from surgical specimens to pathology department personnel is extremely low. There are only three reported cases, all involving conversions to positive tuberculin skin tests after using an aerosolized gas coolant to freeze a tissue block during an intraoperative consultation. ^, Transmission of other types of infectious disease is possible by aerosolization of tissues, needle-stick injury, scalpel wounds, and mucocutaneous exposure during the processing of pathology specimens ( Table 6.3 ). Pathology personnel have become infected with hepatitis B virus (HBV), HIV, and TB during the performance of autopsies. In the two surveys of pathologists, 2% and 6% reported infections, but the studies did not identify whether the source of the infection was due to occupation. ^,

The good news is that pathology personnel can take action to protect themselves: by educating themselves about risks, taking physical precautions to protect themselves and others, avoiding the use of hollow-bore needles, making sure they have appropriate vaccinations and undergoing screening for TB. Personnel who are immunocompromised must be especially vigilant.