Female Nurses With Long-Term OR Employment Have Increased Risk of COPD

NEW YORK (Reuters Health) – Female nurses employed in the operating room (OR) for 15 years or more may have an increased risk of developing chronic obstructive pulmonary disease (COPD), according to new findings.

Clinicians in the OR are exposed to several different potentially harmful environmental agents, including surgical smoke and disinfectants, researchers note in JAMA Network Open.

To gauge the long-term association between OR employment and risk of COPD, Dr. Andrew Stokes of Boston University School of Public Health and colleagues evaluated the incidence of self-reported, physician-diagnosed COPD in female nurses in the Nurses’ Health Study.

The researchers looked at the incidence of COPD in more than 75,000 U.S. nurses (mean age, 51 years) who answered questionnaires regarding history of OR employment in 1984 and job type in 1982. None of the nurses had a history of COPD at the 1984 baseline.

Twenty-nine percent of the nurses reported having worked at some point in the OR, and 3% had worked there for 15 or more years.

The researchers tested the link with COPD using several statistical models, including one adjusting for age (model 1), one also adjusting for cigarette smoking status and pack-year of smoking (model 2) and one also adjusting for race/ethnicity, U.S. Census region and body mass index (model 3).

In the third model, OR employment for at least 15 years was associated with a 46% increased risk of COPD compared with no OR employment history (hazard ratio, 1.46; 95% confidence interval, 1.10 to 1.93).

Additionally, the risk of COPD was significantly greater among nurses who provided outpatient care (HR, 1.24; 95% CI, 1.04 to 1.47) as well as nurses who provided inpatient emergency care (HR, 1.31; 95% CI, 1.07 to 1.59) compared with nurses who had an administrative or non-nursing job and no OR employment history in 1982.

The researchers also found that the risk of developing COPD was 69% higher in nurses with OR experience of 15 years or more (HR 1.69; 95% CI 1.25-2.28) compared with nurses who never worked in an OR and had an administrative or nursing-education function or a non-nursing job in 1982.

“Assuming this is indeed a causative finding, this could lead to the need for further adjustments in the protection offered to OR personnel and/or the standards of operating room ventilation,” Dr. Kevin Tzan, assistant professor of anesthesiology at Baylor College of Medicine in Houston, Texas, told Reuters Health by email.

Dr. Tzan, who wasn’t involved in the study, added that there haven’t been any significant changes to the inhaled agents themselves, suggesting the risk for COPD may reach beyond the time frame in this study.

“However, the sheer increase in number of surgeries being performed today versus 20 years ago could potentially mean an increased quantity of exposure,” he added.

Dr. Ilias Kavouras, a professor in the department of environmental, occupational and geospatial health sciences at CUNY Graduate School of Public Health, in New York City, said the COVID-19 pandemic has emphasized the importance of using personal protective equipment (PPE), both in the OR and other healthcare environments.

According to the study authors, modern masks used in the OR have improved upon their filtering efficiency, but these masks, like N95s, may not filter out ultrafine particles commonly found in surgical smoke. “The masks have been always there, but if you don’t wear them well, they are not very useful,” Dr. Kavouras, who wasn’t part of the study, told Reuters Health by email.

Dr. Kavouras also pointed out that more longitudinal study of chemicals in the OR and the effects of occupational exposure is needed.

“When a new chemical or product is introduced, we never really study the long-term impacts of it,” he said. “Likewise, we have no idea what is happening to someone after maybe an exposure at low level over 15, 20, 25 years because these chemicals are meant for short-term use and the attention to the cumulative exposure risk isn’t always a priority.”

Dr. Stokes did not reply to a request for comments.

SOURCE: https://bit.ly/3AJj8sq JAMA Network Open, online September 20, 2021.

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