Risk of Blood Contamination and Injury to Operating Room Personnel

Abstract

The potential for transmission of deadly viral diseases to health care workers exists when contaminated blood is inoculated through injury or when blood comes in contact with nonintact skin. Operating room personnel are at particularly high risk for injury and blood contamination, but data on the specifics of which personnel are at greater risk and which practices change risk in this environment are almost nonexistent. To define these risk factors, experienced operating room nurses were employed solely to observe and record the injuries and blood contaminations that occurred during 234 operations involving 1763 personnel. Overall 118 of the operations (50%) resulted in at least one person becoming contaminated with blood. Cuts or needlestick injuries occurred in 15% of the operations. Several factors were found to significantly alter the risk of blood contamination or injury: surgical specialty, role of each person, duration of the procedure, amount of blood loss, number of needles used, and volume of irrigation fluid used. Risk calculations that use average values to include all personnel in the operating room or all operations performed substantially underestimate risk for surgeons and first assistants, who accounted for 81% of all body contamination and 65% of the injuries. The area of the body contaminated also changed with the surgical specialty. These data should help define more appropriate protection for individuals in the operating room and should allow refinements of practices and techniques to decrease injury.

Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure

“…This is similar to results reported by Jagger et al 8 that showed that residents and attending physicians accounted for 36% and 28% of exposures, respectively, and a French study that observed approximately 35% of BBF exposures occurred among surgeons. 16 Consistent with our results, previous studies have shown procedure duration and estimated blood loss to be risk factors [13][14][15]18 ; at least 1 prior study found an association with number of personnel in the surgical field. 15 Also, another prior study has demonstrated differences in BBF exposures rates across surgical services.…”

“…16 Consistent with our results, previous studies have shown procedure duration and estimated blood loss to be risk factors [13][14][15]18 ; at least 1 prior study found an association with number of personnel in the surgical field. 15 Also, another prior study has demonstrated differences in BBF exposures rates across surgical services. 32 Although the lack of association between shift and BBF exposures may be surprising, this finding is consistent with 1 study that examined all BBF exposures at a university hospital and found no association with time of day.…”

“…6,[8][9][10][11][12] Many studies focusing on risk of BBF exposures in operating rooms (OR) have examined the effectiveness of safety measures such as double-gloving, the use of blunt suture needles or other safety devices, and neutral instrument passing zones. 4,[13][14][15][16][17][18][19][20][21][22][23][24] Although some studies have examined the characteristics of the surgical procedures, [13][14][15]18 other studies of BBF exposures have been mostly descriptive, focusing on the distribution of events by categories such as type of exposure, surgical service, occupation, and device type. 6,8,12,[25][26][27] The current study presents descriptive statistics of BBF exposures occurring in the OR and examines properties of the procedures, gathered in administrative data sources, to determine whether these predict the risk of exposure during surgical procedures.…”

Surgeons’ and residents’ double-gloving practices at 2 teaching hospitals in Ontario

“…10,11 Surgeons and surgical residents are usually at higher risk for PIs than other operating room personnel. [12][13][14][15][16] Makary and colleagues 17 found that by their final year of training, 99% of surgical residents had had a needle-stick injury. Despite high PI rates, PI underreporting among surgeons remains the highest among hospital workers.…”

The Orthopaedic Surgeon and HIV in Jamaica

“…Appropriate protective draping and garments made of non-woven impervious materials are required to provide an effective barrier between the patient and the surgical team. The likelihood of body contamination increases as the blood loss or surgical time increases [20][21][22][23]. Techniques to reduce surgical time for example using bone graft substitutes instead of autologous iliac crest grafting is a consideration [24].…”