Abstract
This paper reports physical, psychological, and chemical hazards relevant to western Canadian veterinarians as obtained by a self-administered mailed questionnaire. Nine-three percent (750/806) of veterinarians reported some form of injury during the previous 5 years; 17% of respondents (131/791) indicated injuries that resulted in 1 or more days off work. Median stress levels were similar across work environments; overall, 7% (57/813) indicated either no stress or severe stress, while 53% (428/813) indicated moderate stress. Twenty percent (3/15) of food animal practitioners and 37% (114/308) of companion animal practitioners who took X-rays reported accidental exposure. Accidental exposure to gas anesthetic was reported by 69% (394/570) of those in private practice. Exposure to chemicals occurred in all work environments. Veterinarians in western Canada are at risk of minor to severe injury due to both animal and non-animal related causes.
Résumé
Risques pour la santé des travailleurs en médecine vétérinaire : dangers physiques, psychologiques et chimiques. Cet article présente un rapport sur les dangers physiques, psychologiques et chimiques visant les vétérinaires de l’Ouest canadien dans le cadre d’un questionnaire à remplir soi-même acheminé par la poste. Quatre-vingt-treize pour cent (750/806) des vétérinaires ont signalé une forme quelconque de blessure au cours des 5 années précédentes; 17 % des répondants (131/791) ont signalé des blessures qui ont nécessité une absence de 1 journée ou plus du travail. Les niveaux de stress médians étaient les mêmes dans tous les milieux de travail; dans l’ensemble, 7 % (57/813) ont signalé soit l’absence de stress ou un stress prononcé, tandis que 53 % (428/813) ont signalé un stress modéré. Vingt pour cent (3/15) des praticiens pour animaux destinés à l’alimentation et 37 % (114/308) des praticiens pour animaux de compagnie qui prenaient des radiographies ont signalé l’exposition accidentelle aux rayons X. L’exposition accidentelle aux gaz anesthésiques a été signalée par 69 % (394/570) des vétérinaires en pratique privée. L’exposition aux produits chimiques s’est produite dans tous les milieux de travail. Les vétérinaires de l’Ouest canadien s’exposent à des risques de blessures mineures à graves en raison de causes attribuables aux animaux et d’autres causes.
(Traduit par Isabelle Vallières)
Introduction
The veterinary profession is comprised of a diverse group of individuals who interact with a wide variety of animal species under working environments which carry occupational hazards and risk of injury. Veterinarians in private practice, particularly those who work with small animals, may take X-rays, perform surgery, use gas or injectable anesthetics, and administer cytotoxic drugs. Individuals who work with large animals are often in unpredictable situations that expose them to physical injury. Even with safe workplace practices, hazards resulting in minor to severe injury occur within the profession.
The practice of veterinary medicine involves the risk of physical injury through contact with animals and equipment, repetitive motion, and motor vehicle accidents. In a German study, the rate of accidents reported to an insurance database was 2.9 times higher for veterinarians than for physicians in general practice (1). Between 34% and 71% of respondents to published mail-out self-administered surveys indicated at least 1 injury during 3- to 5-year study periods (2–6). Reported risk factors included working with large animals, working in the afternoon, lifting heavy objects (including animal patients), and gender (4,5). More recent work described a lower incidence of needlestick injuries in large animal practitioners compared with companion or mixed animal practitioners (7).
While most publications to date have examined physical and chemical risks, the assessment of psychological hazards is an area of growing interest. A study of Australian veterinarians reported drug abuse, stress due to workload, robbery, and suicide (6). Whether these stressors differ between practice owners and associates or different work environments has not been reported.
Chemical hazards to veterinarians can include exposure to anesthetic gases, X-rays, pesticides, prostaglandins, formaldehyde, antibiotics, and chemotherapeutic agents (8). A number of these substances have been implicated in cancer development or fetal loss (9), and the effects of exposure during pregnancy have been examined in female veterinarians (10,11).
In 2009, a questionnaire exploring a wide range of occupational hazards was mailed to veterinarians in western Canada. This paper describes the physical, psychological, and chemical hazards reported in the survey results.
Materials and methods
In June 2009, a questionnaire was mailed to all veterinarians in western Canada (Alberta, Saskatchewan, and Manitoba) who were listed in 2008 as members of the Canadian Veterinary Medical Association (CVMA). All veterinarians in the 3 prairie provinces are members of the CVMA. British Columbia was not included because a similar survey had recently been completed through their provincial association.
Approval for the study was obtained from the University of Saskatchewan Behavioural Ethics Board. The envelope mailed to each participant contained a cover letter describing the study and its purpose, a questionnaire, and a stamped and addressed return envelope. Veterinarians were asked to complete the questionnaire and return it in the envelope provided. A reminder was sent in July 2009 to all clinics with listed e-mail addresses (approximately 60% of veterinarians). Completed questionnaires were accepted up to October 30, 2009.
Data were collected on demographics, physical, psychological, chemical, and biological hazards. Recall for each response was limited to occurrences within the last 5 y. Individual responses were categorized by the type of veterinary work indicated by the participant: private practice, industry, government, or academia. Those who had retired, relocated, or experienced disability in the last 5 y were asked to describe their previous type of work in an open-ended question. Only questionnaires from individuals who had veterinary work experience within the past 5 y were included in the analysis. Most questions were closed, with participants asked to rank or select from a list of options. Four open-ended questions were included at the end of the questionnaire to capture other issues of importance. The answers to these questions were used informally; the comments were incorporated where appropriate in the discussion portion of the paper only. All respondents did not answer all questions in the questionnaire; thus, the denominator provided with all data that follow indicates the number of individuals who answered that particular question.
The types of species encountered during occupational activities were summarized as a single category for each veterinarian. Those who worked with food animals, equine, and companion animals were classified as “mixed;” those who worked with zoo, laboratory, wildlife or marine animals were classified as “other.” “Food” and “companion” animals included relevant exotic species; “equine” was greater than 90% of time working with equine; and “no animals” referred to those with no job-related animal contact. Occupational species exposure was further categorized as either including large animal (included food, equine, and mixed animal) or not including large animal (companion animal and other) contact.
Injury was described by a series of yes or no answers to specific injury categories: needlestick or scalpel injury, back or limb strain, trips and falls, assaults, concussions, vehicle accidents, hearing loss, animal-related injury, and other. Accident-prone individuals were defined as those who indicated 25 or more injuries over a 5-year period. Stress was evaluated on a scale of 1 to 5, where 1 was no stress, 3 was moderate stress, and 5 was severe stress. Additionally, specific stressors were identified with an opportunity for participants to identify other stressors that they felt were important. Accidental exposure to X-rays included incidents in which the veterinarian did not leave the area and did not wear protective gear during the X-ray procedure. Various chemicals and drug exposures were examined including anesthetics, cytotoxic drugs, disinfectants, and manual X-ray processing chemicals.
Data were entered into a computerized database and checked for errors. Data were then summarized using frequency tabulations for categorical variables and means and standard errors for continuous variables (SPSS v.17, SPSS, Chicago, Illinois, USA). Stress was summarized as a median and further evaluated for significance with specific predictors using appropriate non-parametric statistics.
For veterinarians in private practice, multiple logistic regression was used to estimate the strength of associations between potential risk factors of interest and adverse outcomes (injury, accident-prone injury, injury leading to days off work, accidental exposure to X-rays, and exposure to pesticides). The strengths of associations were reported as odds ratios (OR) with 95% confidence intervals (95% CI). In the case of correlated or co-linear potential risk factors, only 1 variable was selected for inclusion in the final multivariable model based on significance values. Factors were identified as confounders and retained in the models if their inclusion or removal changed the effect estimate for factors of interest by more than 10%. Biologically reasonable two-way interactions were assessed between significant risk factors (P < 0.05) and included only if statistically significant.
Due to the anonymity of the survey participants, characterization of non-respondents to assess a potential bias due to a moderate response rate could not be achieved. Instead, individual responses were categorized as to the date they were received; early respondents were received within the first month and all others were later respondents. Comparisons of individual characteristics and specific outcomes of interest were made for early and later respondents in order to assess the potential for bias in this study design.
Results
Response rate and demographics
Of the 2187 surveys mailed to veterinarians, 116 envelopes were returned due to death, long-standing retirement, or no forwarding address. The overall response rate for eligible surveys was 41% (849/2071). Individual surveys were excluded from the analysis if the individual had been retired for more than 5 y (n = 19), had answered questions relating to a period of time more than 5 years ago (n = 1), or was currently not working in the veterinary profession due to disability, change of occupation, or leave for more than 5 y (n = 6). A total of 823 surveys were included in the analysis (Table 1), 131 from Manitoba, 210 from Saskatchewan, and 482 from Alberta (response rates of 38%, 41%, and 39%, respectively).
Table 1.
Description of survey participants: gender, species exposure, and work environment
| Variable | Category | Number |
|---|---|---|
| Gender | Male | 368 |
| Female | 451 | |
| Primary species contact | Companion | 369 |
| Food | 103 | |
| Equine | 42 | |
| Mixed | 238 | |
| Other | 30 | |
| No animals | 41 | |
| Work environment | Practice | 625 |
| Academia | 91 | |
| Industry | 43 | |
| Government | 64 |
Of respondents who graduated in the 1960’s, only 1 was female (3%); in the 1970’s, 21% were female (30/141); in the 1980’s, 49% were female (90/184); in the 1990’s, 66% were female (148/223); and in 2000 or later, 76% were female (180/238). Most companion animal practitioners were located in urban locations (304/336, 90%), while the majority of food and mixed animal practitioners were located in rural areas (39/47, 83% and 162/209, 78%, respectively).
A comparison of early and late respondents revealed that there was no statistical difference for all individual characteristics and these specific outcomes of interest: exposure to X-ray, injury, and median stress levels.
Physical hazards
Ninety-three percent (750/806) of veterinarians reported some form of injury during the previous 5 y (Table 2). The majority of veterinarians who indicated when they were most likely to be injured reported the highest risk time as the regular work day (553/678, 82%), 4% (24/678) reported after hours, and 18% (121/678) reported both during and after regular hours. Ninety-eight percent of veterinarians in practice (603/618) versus 78% of veterinarians outside of practice (147/189) indicated an injury in the last 5 y (P < 0.001). Within the last 5 y, 26% (214/810) of veterinarians reported accidental exposure to vaccines (West Nile virus, Giardia, Leptospira spp.) due to needlesticks. Seven individuals reported some form of disability in the past 5 y.
Table 2.
Types of injuries reported by veterinarians responding to the survey (N = 806)
| Category of Injury | Practice n = 618
|
Inda n = 41 (%) |
Gova n = 61 (%) |
Acada n = 86 (%) |
Total N = 806 (%) |
||||
|---|---|---|---|---|---|---|---|---|---|
| Compa (%) | Food (%) | Equine (%) | Mixed (%) | Total (%) | |||||
| Injured — Yes | 321 (96) | 46 (100) | 27 (96) | 209 (99) | 603 (98) | 32 (78) | 49 (80) | 66 (76) | 750 (93) |
| Needlestickb | 215 (65) | 28 (61) | 15 (54) | 146 (69) | 404 (65) | 12 (29) | 19 (31) | 29 (34) | 465 (58) |
| Back strain | 92 (28) | 19 (41) | 11 (39) | 87 (41) | 209 (34) | 13 (32) | 14 (23) | 18 (21) | 254 (31) |
| Limb strain | 59 (18) | 23 (50) | 11 (39) | 102 (48) | 195 (32) | 9 (22) | 16 (26) | 18 (21) | 238 (30) |
| Scalpel | 89 (27) | 25 (54) | 9 (32) | 119 (56) | 242 (39) | 13 (32) | 9 (15) | 15 (17) | 279 (35) |
| Fall | 25 (8) | 11 (24) | 6 (21) | 62 (29) | 104 (17) | 8 (20) | 17 (28) | 12 (14) | 141 (17) |
| Hearing loss | 2 (0.6) | 6 (13) | 2 (7) | 6 (3) | 16 (3) | 5 (12) | 4 (7) | 2 (2) | 27 (3) |
| Vehicle accident | 2 (0.6) | 5 (11) | 4 (14) | 8 (4) | 19 (3) | 1 (2) | 5 (8) | 1 (1) | 26 (3) |
| Assault | 6 (2) | 0 (0) | 1 (4) | 1 (0.4) | 8 (1) | 1 (2) | 2 (3) | 1 (1) | 12 (1) |
| Concussion | 1 (0.3) | 3 (7) | 0 (0) | 8 (4) | 12 (2) | 0 (0) | 0 (0) | 0 (0) | 12 (1) |
| Non-concussion (head injury) | 6 (2) | 3 (7) | 4 (14) | 29 (14) | 42 (7) | 1 (2) | 1 (2) | 4 (5) | 48 (6) |
| Burns/frostbite/heatstroke | 12 (4) | 8 (17) | 3 (11) | 35 (17) | 58 (9) | 2 (5) | 8 (13) | 3 (3) | 71 (9) |
| Otherc | 8 (2) | 5 (11) | 1 (4) | 10 (5) | 24 (4) | 1 (2) | 3 (5) | 4 (5) | 32 (4) |
| Bite/scratch | 309 (93) | 10 (22) | 14 (50) | 185 (88) | 518 (84) | 15 (37) | 18 (30) | 35 (41) | 586 (73) |
| Crush/kick/trample | 39 (12) | 31 (67) | 24 (86) | 167 (79) | 261 (42) | 12 (29) | 20 (33) | 25 (29) | 318 (39) |
Comp — companion animal; Ind — Industry; Gov — Government; Acad — Academia.
Needlestick includes both recapping and non-recapping incidents.
Other includes amputations, front teeth knocked out, bruised kidneys, broken bones.
Forty percent (318/794) of veterinarians indicated they visited a physician at least once for injuries incurred during professional activities. Most veterinarians reporting injuries (55%, 176/318) visited a physician only once, but 1 person visited > 30 times over 5 y. Forty-six individuals (7%, 46/695) indicated they had 25 or more injuries over the 5-year period; 43 of these worked in private practice. Only 17% of respondents (131/790) indicated injuries that resulted in 1 or more days off work; 76% of those missing work for an injury (100/131) stated these were one-time occurrences, but 1 individual reported 20 occurrences in the 5-year period.
For practicing veterinarians only, gender, decade of graduation, and whether they ever worked with large animals were unconditionally associated with injury; all 3 variables were included in the final multivariable model (Table 3). Veterinarians who reported working with large animals were more likely to report injuries resulting in 1 or more days off work than those who had no large animal exposure (OR = 2.2, 95% CI: 1.5, 3.3). None of the risk factors examined were associated with the odds of reporting ≥ 25 injuries in 5 y (accident-prone) compared with those reporting < 25 injuries.
Table 3.
Multivariate analysis (odds ratio and 95% confidence intervals) for factors associated with injury, accidental exposure to X-rays, and use of pesticides for private practitioners only
| Variables | Injury N = 614 |
Accidental exposure to X-rays N = 533 |
Accidental exposure to gas anesthetic N = 567 |
Pesticides N = 617 |
|---|---|---|---|---|
| Gender | ||||
| Male | Ref a | NA | Ref | NA |
| Female | 3.4 (1.0, 11.8) | 1.9 (1.3, 2.9) | ||
| Work | ||||
| No large animals | Ref | NA | 1.6 (1.1, 2.4) | Ref |
| Large animals | 4.7 (1.2, 17.4) | Ref | 2.4 (1.7, 3.9) | |
| Grad decade | ||||
| 1960–1989 | Ref | Ref | Ref | 1.7 (1.2, 2.4) |
| 1990–2009 | 4.5 (1.2, 17.1) | 3.2 (2.2, 4.7) | 4.9 (3.2, 7.5) | Ref |
Ref — Reference.
NA — not used in analysis.
Psychological hazards
Two percent of veterinarians (15/812) indicated no job-related stress, 5% (42/812) indicated severe stress, while the majority (53%, 427/812) indicated moderate stress. Median stress levels reported among veterinarians working in practice, industry, government, or academia were not significantly different (P = 0.74); for each group, the median reported stress value was 3 on a scale of 5. Stress was higher for those who had graduated in the past 2 decades compared with pre-1990 graduates (P = 0.005), for females compared to males (P < 0.001), and for those who worked more than a 40-hour work week (P = 0.001). The types of stresses individuals reported differed among work environments; workload and client-related issues were highest for veterinarians working in a practice (Table 4).
Table 4.
Number of respondents by categories of stress-related issues by working conditions
| Stress category | Practice | Industry | Government | Academia | P-value |
|---|---|---|---|---|---|
| Workload-related | |||||
| Yes (%) | 492 (79) | 30 (70) | 40 (63) | 58 (64) | 0.001 |
| Staff-related | |||||
| Yes (%) | 457 (73) | 26 (60) | 48 (75) | 65 (72) | 0.31 |
| Client-related | |||||
| Yes (%) | 386 (62) | 11 (26) | 17 (27) | 27 (30) | < 0.001 |
| Burglary-related | |||||
| Yes (%) | 37 (6) | 2 (5) | 0 (0) | 4 (4) | 0.23 |
| Othera | |||||
| Yes (%) | 22 (4) | 5 (12) | 6 (9) | 6 (7) | |
Other includes economic recession, travel, flooding, death threats, demonstrating academic performance, etc. No statistical analysis was done on this group as it was a collection of un-related factors.
Thirteen individuals (2%) indicated being physically injured or assaulted by a client between 1 and 3 times over a 5-year period; 11 of these individuals were in private practice with no difference between genders (P = 0.93). Sixty percent of respondents (456/764) reported verbal abuse by clients in the past 5 y, 66% of whom (302/456) recalled at least 1 to 4 episodes and 1 individual reported 500 or more occurrences over a 5-year period. The most commonly cited reason for verbal abuse by clients was inability to pay (271/456), followed by dissatisfaction (216/456), adverse outcomes to procedures (147/456), and wanting procedures that the veterinarian was unwilling or unable to provide (100/456).
Eleven percent (87/790) of respondents indicated seeking the services of a physician, counselor, or psychiatrist for workload or client-related stress over the 5-year period. Seven percent (52/790) indicated missing work for 1 or more days due to workload or client-related stress.
X-ray, chemical, and other hazards
Ninety percent of respondents in private practice (558/622) reported taking X-rays as part of their job (Table 5). Restraint of animals during X-rays was common for all veterinarians in private practice regardless of which species they worked with most (Table 5). Of those who restrained animals, 39% (200/509) indicated that they also had accidental exposure. Those who had graduated after 1990 were more likely to take X-rays (88% versus 66%), restrain animals during X-ray procedures (96% versus 89%), and report accidental exposure to X-rays than those who had graduated before 1990 (Table 3).
Table 5.
Summary of data on veterinarians exposed to X-rays, chemicals, and drugs based on type of work environment and their gender
| Variable | Practice
|
Ind/Gova (%) | Acada (%) | Females in Practice (%) | ||||
|---|---|---|---|---|---|---|---|---|
| Compa (%) | Food (%) | Equine (%) | Mixed (%) | Total (%) | ||||
| X-ray | ||||||||
| Take X-rays | 320 (95) | 15 (33) | 27 (96) | 196 (92) | 558 (90) | 34 (33) | 49 (55) | 337 (92) |
| Accidental exposure to X-raysb | 114 (37) | 3 (20) | 12 (49) | 79 (42) | 208 (39) | 6 (21) | 13 (30) | 132 (41) |
| Restrain animals for X-raysb | 300 (94) | 13 (87) | 22 (85) | 195 (99) | 530 (95) | 28 (84) | 35 (74) | 324 (96) |
| Chemicals | N = 335 | N = 46 | N = 28 | N = 211 | N = 620 | N = 101 | N = 86 | N = 365 |
| Cleaning agents | 253 (76) | 27 (59) | 17 (61) | 184 (87) | 481 (77) | 55 (54) | 50 (58) | 281 (77) |
| Disinfectants | 296 (88) | 36 (78) | 23 (82) | 197 (93) | 552 (89) | 71 (70) | 66 (76) | 329 (90) |
| Preservatives | 288 (86) | 41 (89) | 26 (93) | 204 (97) | 559 (90) | 70 (69) | 67 (77) | 328 (90) |
| X-ray chemicals | 178 (53) | 7 (15) | 12 (43) | 120 (57) | 317 (51) | 12 (12) | 11 (13) | 180 (49) |
| Pesticides | 141 (42) | 24 (52) | 10 (36) | 145 (69) | 320 (52) | 26 (26) | 25 (29) | 176 (48) |
| Drugs | N = 336 | N = 46 | N = 28 | N = 212 | N = 622 | N = 99 | N = 83 | N = 368 |
| DMSOc | 95 (28) | 18 (39) | 26 (93) | 143 (67) | 282 (45) | 18 (18) | 23 (28) | 143 (39) |
| Fentanyl | 203 (60) | 4 (9) | 4 (14) | 98 (46) | 309 (49) | 13 (13) | 28 (28) | 212 (58) |
| Reproductive drugs | 87 (26) | 42 (91) | 24 (86) | 206 (97) | 361 (58) | 24 (24) | 28 (33) | 196 (53) |
Comp — companion animal; Ind — Industry; Gov — Government; Acad — Academia.
Only answered for those who took X-rays.
DMSO — dimethyl sulfoxide.
Ninety percent (495/549) of all private practice veterinarians reported having their own dosimeter; 60% (32/54) of those in practice without their own dosimeter had graduated within the past decade. Only 14 individuals in private practice and one individual from academia, all of whom had their own dosimeters, reported dosimeter readings of > 20 mSv/year in the previous 5 years. The 14 individuals in private practice reported manually restraining patients for X-rays as part of their job, while the individual from academia did not.
Eighty-eight percent (547/624) of those in private practice reported using gas anesthetic; 94% (587/624) reported using injectable anesthetic. Accidental exposure to gas anesthetic was reported by 69% (394/570) of all individuals in private practice who answered the question; 9 individuals reported exposure despite indicating that they did not use gas anesthetic. For practicing veterinarians only, gender, decade of graduation, number of hours worked in a week, and whether they ever worked with large animals were unconditionally associated with accidental exposure to gas anesthetic; only hours worked per week was not included in the final model (Table 3). Accidental exposure to injectable anesthetic was reported by 8% (47/563) of all those in private practice who answered the question; all exposed individuals reported using injectable anesthetics personally. Year of graduation (P = 0.42), gender (P = 0.50), and working with large animals (P = 0.61) were not associated with the odds of accidental exposure to injectable anesthetics.
Less than 1% of all respondents sought medical attention by a physician (3/796) or missed work for 1 or more days (3/796) due to exposure to anesthetics; all were female veterinarians in private practice. Of the 3 who sought medical attention, only 1 was off work for 1 or more days.
Exposure to chemicals occurred in all work environments but was highest in private practice for all categories (Table 5). Thirty percent of private practitioners (186/621) and 22% (17/78) of academic veterinarians who work with animals administered cytotoxic drugs. Of those in private practice, 91% (169/186) were small or mixed animal practitioners and 8.6% (16/186) were equine practitioners; of those in academia, 8 were small or mixed animal practitioners and 6 were equine practitioners. None of the academic veterinarians reported accidental exposure to cytotoxic drugs; 15 private practitioners reported accidental exposure, 9 of whom were female and 10 of whom worked with companion animals.
Veterinarians in private practice who graduated after 1990 were more likely to use pesticides (P = 0.002), preservatives (P = 0.01), and the drug fentanyl (P < 0.001); however, those who graduated in the earlier decades (1960 to 1989) were more likely to be exposed to pesticides. Veterinarians who worked with large animal species in private practice were more likely to use preservatives, pesticides, dimethyl sulfoxide (DMSO), and drugs for reproduction (P < 0.001); those who did not work with any large animals were more likely to use cytotoxic drugs and fentanyl (P < 0.001). Females in private practice were at equal risk from any of the chemicals in the survey compared with all practitioners.
One percent (6/623) of all respondents sought medical attention from a physician for exposure to drugs or chemicals; 5 of these were females in private practice. Of those who visited a physician, only 2 missed work for 1 or more days. Three veterinarians, all of whom were females in private practice, missed work for 1 or more days due to exposure to drugs or chemicals.
Discussion
The overall prevalence of workplace injuries estimated by this survey is high compared with other studies in which the definitions of injury were different (2,3,6,11). In this survey, 17% of respondents missed at least 1 day of work and 40% visited a physician due to injury; these criteria are indicative of a more severe injury. Animal-related injuries (such as, bites, scratches, kicks, trampling) were the most common; consistent with other studies (2,5,6,8). Prevalence estimates for specific injuries (for example, vehicular accidents, hearing loss, concussions) are consistent with studies of similar design (2,3,5,6,8).
Injury was more likely to occur in females, those who worked with large animals, and those who had graduated during the past 2 decades. The higher injury rates in females have been postulated to relate to the lesser strength of women compared with men (12). Even accounting for the lesser experience of those graduating in the past 2 decades, females were still more likely than males to be injured. Animal bites and scratches were more common in companion animal practice which is also dominated by females. Female veterinarians may also be more likely to report minor injuries, as gender was not a significant predictor of days missed from work due to injury. Injury resulting in days missed from work was more likely in those who worked with large animals, indicating that injuries sustained in this line of work are more common and more severe. High prevalence of injury in large animal workers has been reported in previous studies from North America and overseas (5,6,11).
Needlestick injuries are common in the veterinary profession, with 58% of respondents reporting a needlestick in the past 5 y. A recent study of animal health technicians indicated that 74% reported at least 1 needlestick injury in the past year (13). Needlestick injuries may involve the risk of self-injecting drugs or other harmful substances, which can result in allergic reactions or other more severe sequelae (7,14). One report of self-injection with a prostaglandin compound resulted in a spontaneous abortion in the female veterinarian (7). A recent review article provided indications of precautions that could be instituted to prevent needlestick injuries (14); the primary method for decreasing needlestick injuries is to avoid recapping needles or at the very least use a “one-handed scooping technique” to recap. Compliance with this simple infection control procedure may substantially reduce this form of occupational injury.
Stress levels reported in this study were greater for females, those recently graduated, and those who worked more than a 40-hour work week. Authors of a recent systematic review of the literature on stress specific to veterinarians from various countries commented that veterinarians were in general not significantly more stressed than the general public, and females experienced higher stress levels as did younger veterinarians (15). Anecdotally, stress is often reported as a reason for a change in job status; however, overall stress levels in this study were not different across the various work environments. The specific types of stressors were different among the various working environments, with private practice over-represented by workload (specifically long work hours and being on-call) and client-related stresses (specifically client complaints).
Two recent studies from Australia comment on stress, with specific reference to suicide, assault, and robbery (6,8). Neither provided an indication of the amount of stress which individuals felt in their employment settings but rather focused on specific types of stressors which could contribute to stress in the work-place. This study did not capture information on attempts at suicide but private practice and academic veterinarians reported similar levels of burglary-related stressors (6%) and 1% of respondents in practice reported assaults. The workplaces of these veterinarians stock many highly addictive drugs (such as, ketamine, narcotics). Veterinarians taking after-hours calls, especially in rural or secluded urban areas, may be particularly at risk of assault-related incidents (16). Veterinarians can be proactive by inspecting their clinics for safety hazards, learning the early warning signs displayed by those who might become violent, and instituting safe after-hour work practices in the clinic (16).
Informal comments from survey respondents indicated that they had never fully considered the impacts of stress on their work. Respondent comments relating specifically to stress included phrases such as “under-recognized,” “likely to drive me to seek new employment,” and “present the greater overall negative force acting on vets.” Many respondents indicated multiple stressors in their jobs. Mechanisms for coping with stress outside of counseling include balancing work and home life, extra-curricular activities, and taking vacation time (15).
Anyone present in the room during X-ray procedures may run the risk of exposure to radiation. The dose of radiation received by an individual depends on the number of X-rays taken, the protection devices used, the machine type and settings, distance from the X-rays, and whether physical restraint of the patient is employed or not (10). The proportion of veterinarians in practice who reported taking X-rays (90%) is consistent with an Australian study (94%) but slightly higher than 2 all-female studies (79% to 82%) (6,10,11). Private practitioners who graduated after 1990 were more likely to take X-rays, restrain animals, and report accidental exposure to X-rays, similar to data from another study (10). Those individuals without their own dosimeter were over-represented by those who graduated in the last decade; educational institutions should reinforce to graduating veterinarians the necessity for individual dosimeters.
This survey revealed that 95% of practitioners restrained animals while taking X-rays; higher than other studies have reported (10,11). Despite the common use of restraint, only 39% of practicing veterinarians indicated accidental exposure. With proper protective gear, the risks associated with taking X-rays are diminished. Positioning of animal patients for X-rays often necessitates physical force whether the animal is sedated or not; however, film holders and the use of strings or other arm propping devices such as foam wedges can limit the need for individuals to stand close to or directly within the beam.
Anesthetic gases used in veterinary practice include halothane, isoflurane, and sevoflurane. Accidental exposure most commonly occurs through improper waste gas scavenging or gas escaping from masked animals during surgeries. Low-level exposure to these gases can result in mild or severe acute or chronic symptoms, but exposure is of particular concern to pregnant females. Preventive strategies include scavenger systems to increase ventilation in surgery rooms, using alternate induction techniques, or avoiding surgery by pregnant veterinarians. In this study, reports of accidental exposure to gas anesthetics were high (69%), but less than 1% reported visiting a physician or missing work for 1 or more days as a result. At a minimum, practices should provide adequate waste gas scavenging and continue to work to reduce accidental exposure via altered induction methods, such as using injectable anesthetics.
No prior studies have discussed the potential morbidity or mortality due to exposure to chemicals in veterinary practice. The chemicals are hazardous at certain concentrations or exposures but no data are available to address how interactions between the chemicals would affect individuals. The resulting best practices guidelines suggest that safety precautions should be taken by individuals when handling these chemicals and drugs.
Pesticide exposure in veterinary practice commonly occurs through the use of flea dips or topical insecticides, such as pyrethrins or carbamates. Pyrethrins have low mammalian toxicity while carbamates may result in central nervous system effects. Veterinarians having more work experience (graduating 1960 to 1989) were more likely to be exposed to pesticides despite this group using them less frequently. Both small animal and large animal practitioners had been exposed to pesticides; however, without information on the quantity, differences between practice types could not be discerned.
Cytotoxic drugs, such as doxorubicin or vincristine, are mutagenic, carcinogenic, teratogenic, and irritating to humans, especially pregnant females (17). These drugs are frequently encountered in small animal practice. Routes of exposure include accidental injection, inhalation, ingestion, or mucosal absorption from the drug itself or from patients’ excretions after drug administration (17). Minimum precautions when working with these substances should include proper personal protective gear, such as gloves, mask, goggles, and a long-sleeved water-resistant gown. With 8% of veterinarians in private practice who administer cytotoxic drugs reporting accidental exposure, greater vigilance is required in addition to future studies to document the potential biological effects on the workers exposed to these drugs.
No information was collected on pregnancy and exposure to X-rays or other hazards in this survey; however, the prevalence of accidental exposure (for example, to X-rays, chemicals) was similar for all those in practice compared to females only in practice. Women may take more precautions to avoid exposure during pregnancy but this was not evident as an overall rule.
The response rate was adequate for an anonymous mail-out survey design (18). Limitations in this study include no analysis of non-responders, no retrospective data collection, an inability to differentiate injury by severity, no information on whether protective measures were in use at the time of injury, and no measurement of actual levels of exposure to X-ray, anesthetic, or chemical hazards. A comparison of respondents who replied in the first month compared to later respondents showed that there was little influence of a lower response-rate bias in the data. Overall, the participants were representative of the profession in Canada; with slightly more females responding than males compared with the national averages (19,20).
Occupational hazard avoidance is the responsibility of each individual in the profession. However, practice owners should be aware of the risks and institute practice-wide prevention strategies where appropriate to minimize injury and hazardous exposures in their employees. Academic institutions are especially concerned with occupational hazard avoidance, with committees created with the mandate to discuss and determine best practice guidelines and minimum standards for the safety of all employees. This is the first published report of the prevalence of hazards in the veterinary profession in western Canada. The study considered the prevalence of injury, level of stress, and exposure to potentially harmful substances and highlights that women, those who work with large animals, and recent graduates are more at risk for physical, psychological, and chemical hazards in the work place. These findings are a starting point for further investigations into the prevention of workplace hazards and a stimulus for targeted injury prevention measures that could be instituted by individuals, practices, and veterinary governing bodies. CVJ
Footnotes
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Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office (hbroughton@cvma-acmv.org) for additional copies or permission to use this material elsewhere.
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