Table 1 Risks to in-hospital resuscitation teams and potential preventive strategies to mitigate risk
From: Hospital resuscitation teams: a review of the risks to the healthcare worker
Risk category | Specific risks and potential exposures | Potential preventive actions and solutions |
|---|---|---|
Infectious | □ Percutaneous/needlestick injuries □ Respiratory/airborne exposures □ Contact exposures □ Emerging/re-emerging infections | □ Convenient sharps disposal □ Use of needles with safety features □ Blood-borne pathogens training for all employees □ Reporting of needlestick injuries with post-exposure medical evaluations and prophylaxis □ Breathing filter during mask ventilation □ Clearly defined roles for staff regarding: who is responsible for blood draw, central line placement, etc. |
Electrical | □ Shock during defibrillation □ ICD misfiring □ Fire generation near oxygen-rich atmospheres | □ Standard maintenance of defibrillators □ Training of resuscitation team members on the use of defibrillators □ Placing a donut magnet over ICDs; consider including on code cart □ Clear announcement of impending defibrillation □ Preferential use of gel adhesive pads instead of hand-held paddles. If paddles are used, avoidance of excess amounts of conduction gel □ Consider removal of supplemental oxygen from bed prior to defibrillation |
Musculoskeletal | □ Neck/back injuries during/following chest compressions □ Falls while running to code situations | □ Training to providers on proper posture and chest compression technique □ Adjust height of bed during chest compressions and/or use of step stools □ Adequate number of chest compressors to allow recovery and reduce resuscitator fatigue |
Chemical | □ Risks of chemical warfare | □ Programs for decontamination of victims of chemical warfare |
Irradiative | □ Exposure during cross-table cervical spine radiographs with manual cervical spine stabilization, generally in trauma patients □ Brachytherapy patients | □ Maximize distance between provider and radiation beam □ Use of lead-lined gloves, lead aprons, thyroid shields, and glasses |
Psychological | □ Traumatic stress with short- and long-term mental and physical impact | □ Stress management programs □ De-briefing following resuscitation efforts, ideally within less than 72 h and in a non-threatening manner □ Counseling and related programs for depression, PTSD and, overall mental health well-being □ Implementation of “death rounds” |