Cath lab work-related pain hits techs, nurses hardest

The strain from wearing protective lead aprons in the cath lab may be taking a greater toll on allied staff than on physicians. A survey on health hazards in interventional labs found incidence of work-related pain was highest among technicians and nurses.

“As physicians, we rotate out of the cath lab,” senior researcher Mandeep Singh, MD, MPH, a cardiologist at the Mayo Clinic in Rochester, Minn., told Cardiovascular Business. For instance, he estimated he spends half his time in a cath lab and the other half outside with other duties. “Employees such as technologists and nursing staff who work in the cath lab or radiation area do not have any other option.”

To assess occupational work hazards in interventional labs, Singh and his colleagues at the Mayo Clinic designed and sent an email survey in 2013 to employees in the cardiology and radiology departments throughout the Mayo system. Respondents who answered positively to questions about participating in procedures involving radiation that required wearing a lead apron were placed in the study group. Those with negative responses served as the control group.

A total of 1,543 workers responded to the survey, with 67.5 percent qualifying to be in the study group. Of those, 54.3 percent were technicians or technologists; 18.3 percent registered nurses; 13.4 percent physicians; 9.3 percent other; and 4.7 percent residents or fellows.

The study group reported a higher prevalence of work-related pain compared with the control group (54.7 percent vs. 44.7 percent). They also had a higher rate of seeking medical care for pain (30.4 percent vs. 24.4 percent) and reporting current pain (28.8 percent vs. 23.4 percent). The researchers found no difference in use of disability, pain medication or absences between the groups, though.

Those who reported a history of work-related pain were more likely to be women, spend more hours per week exposed to radiation and practice behaviors aimed at reducing pain such as stretching or wearing soft-soled shoes. Technicians had the highest reported rate of musculoskeletal pain, at 62 percent, followed by nurses at 60 percent, attending physicians at 44 percent and residents or fellows at 19 percent.

“The 67 percent increase [in prevalence] we saw, even after adjustment for age, years of profession and body mass index, underscores the fact that this is a very high-stress job,” Singh said. “It takes a toll over time.”

The study group did not report higher rates of cancers, cataracts, hypothyroidism or nephrolithiasis than the control group, but the Mayo team speculated that employees with a cancer diagnosis likely would ask to be reassigned to an environment that did not expose them to radiation. Also, the mean age in the study was 43, an age where cancer prevalence is low.  

The results point to the need for a more proactive approach, Singh said. “One of the things we might consider in our institution is to rotate [technicians and nurses] out of the cath lab periodically,” he suggested. “The work-related stress of picking up patients and wearing the lead apron five days a week, it can be lowered a little bit.”

The researchers are considering sending another a survey focusing on the subgroup of staff with the highest prevalence of pain. They also want to pursue questions related to radiation exposure and to continue sending surveys over time to not only identify employees who experience pain but put strategies in place to keep it from worsening.

At the moment, Mayo has not formally stated plans to leverage the findings but Singh anticipates they could spark changes. “This study is a preamble toward putting a draft and also making an institutionwide effort to improve employee health,” he said.

The study was published in the March 3 issue of the Journal of the American College of Cardiology.