Blood contamination of anaesthetic and related staff

Abstract

Summary Key wordsInfection; Hepatitis B, acquired immune deficiency syndrome. Anaesthetists; complications.The Association of Anaesthetists advises all anaesthetists to wear gloves in the operating theatre for vessel cannulation and insertion or removal of airways and tracheal tubes.' The Expert Advisory Group on the acquired immune deficiency syndrome (AIDS) also recommends gloves to be worn, as a minimum protective measure, for any procedures where there is likely to be contact with blood.2 This advice was produced as a response to growing concern about the risk to operating theatre staff of infection from blood and secretions from patients with hepatitis or human immune deficiency virus (HIV) infection."This study has three objectives: to determine, the incidence of skin contamination of anaesthetic and related staff by patient's blood and saliva during a normal working week, the current Hepatitis B immunisation status of anaesthetists in Cardiff and the incidence of glove usage. MethodsA questionnaire which asked about skin contamination by blood and saliva was attached to each anaesthetic record of every patient who received an anaesthetic in the main operating theatres at University Hospital of Wales and Cardiff Royal Infirmary for a 7-day working week in October 1989. The type of operation, nature of surgery (elective or emergency), grade of anaesthetist and occurrence of skin contamination by blood or saliva were recorded.Each anaesthetist in Cardiff was interviewed to determine whether he or she routinely wore gloves for oral or nasal tracheal intubation, the insertion of peripheral venous cannulae, arterial cannulae or central lines. Hepatitis B immunisation status was recorded. Comments were also sought as to the reasons why each did not routinely wear gloves in the operating theatre. Results Skin contamination by patients' blood and salivaTwo hundred and seventy anaesthetics were administered during the 7-day continuous period in the two hospitals, of which 252 (93%) forms were returned. Eighty-three percent (209) had elective surgery and 17% (43) emergency surgery. A total of 256 peripheral cannulae (some patients had more than one peripheral line while others had a venous cannula already in situ), 21 arterial lines and 20 central lines (nine drum catheters and 11 internal jugular lines) were inserted.Blood from 14% (35) patients caused skin Contamination of 65 people during 46 incidents (there was often more than one contamination incident per patient). Seventy-six percent (27) of the 35 patients involved in blood con-

Touch sensitivity with sterile standard surgical gloves and single‐use protective gloves

“…Harrison et al reported that anaesthetists prefer sterile surgical gloves to protective gloves even for simple invasive procedures such as puncturing a peripheral vein because they feel surgical gloves are of better quality [4]. Various authors and national societies have declared the use of sterile gloves to be standard procedure, although it is not always clear at what degree of invasiveness sterile gloves become a necessity [1,2,7].…”

“…Noticeable impairment of touch sensitivity caused by wearing gloves increases the number of unsuccessful punctures, reduces patient comfort and also reduces the physician's willingness to wear gloves [4].…”

“…Nevertheless, the number of physicians willing to wear gloves, for example when puncturing peripheral veins, is still very low despite knowledge of the potential risks [3]. The most commonly given reason for not wearing gloves is loss of sensitivity and touch [4]. Surgical gloves are often preferred to protective gloves as they are perceived to be of better quality.…”

The use of protective gloves, the incidence of ampoule injury and the prevalence of hand laceration amongst anaesthetic personnel

“…The overall incidence of glove wearing at the Bristol Royal Infirmary is probably much higher than in previous studies in 1989 [9] and 1992 [6, 121. However, despite repeated recommendations that gloves should be worn routinely and education of the risks of hepatitis and HIV, the incidence of glove wearing does not approach 100%.…”

“…The risk of needle stick injury has been well defined [5,6] and measures have been recommended to reduce the incidence [7]. It is recommended that protective gloves should be worn during the administration of anaesthesia [8], although it is well known that many anaesthetists choose to ignore this recommendation and have a high risk of direct contact with patients' blood [9]. It has been suggested that the prevalence of hepatitis B seroconversion is higher in anaesthetists who wear gloves only when performing sterile procedures [ 101.…”