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Medical Meeting Reports

American College of Surgery Clinical Congress

October 10-15, 1999


HOW TO PROTECT SURGEONS AND PATIENTS FROM TRANSMISSION OF BLOOD-BORNE DISEASES
font=>by Paul Recchia, Ph.D.

The risk of percutaneous exposure in the operating room (OR) are greatest for hepatitis B at (6-30%), intermediate for hepatitis C (1.8%), and very low for HIV (0.3%), according to the Centers for Disease Control (CDC). While there are chemotherapeutic treatments for HIV, and a vaccine for HepB, there is no vaccine and no treatment for HepC. What is worse is the 50-80% risk of exposed people becoming chronic from exposure to HepC, while with HepB, only 5% become chronic. So, along with HIV and HepB, HepC has become a real and growing threat to surgeons and patients in the OR. To reduce the risk of transmitting these diseases, the surgeon must change the OR environment.

Edward Quebbeman, MD, Medical College of Wisconsin, discussed three approaches that decrease risk by reducing blood exposure and injury: engineering new instruments (e.g.: blunt suture needles), personal safety equipment (e.g.: proper gown), and education (e.g.: wearing double gloves).

Engineering Controls

Engineering better surgical devices can be a very effective way to decrease risk. One example is the use of blunt suture needles to close the abdomen and chest, reducing the otherwise frequent exposure of needle sticking during surgery. The limit of engineering devices is the limit of the technology. For example, the blunt suture needle can not be used on skin, while another technology does helps on skin: stapling.

Personal Safety Equipment

Adapting equipment use can reduce blood transmission, especially in the case of long, complex surgical operations. For example, a gown with the proper material design can reduce blood contamination to the body of the surgeon. Inadequate material used during a long operation ensures blood will eventually soak through an improperly designed gown. There are three basic types of gowns: single, reinforced chest, and plastic reinforced. Selecting the proper gown for the length of surgery will keep blood off surgeons' skin.

Double Gloving Prevents Transmission

It is generally recognized that the longer the operation, the greater the chances of blood contamination to the fingers and hands. Dr. Quebbeman conducted a randomized study on double-gloving verses single-gloving. The study showed that contamination occurred in 6-9% of double-gloved surgeons, while in 40-70% of single glove surgeons. The investigators clearly demonstrated a statistically significant reduction in blood contamination to surgeons wearing double-gloves. The additional discomfort of wearing double-gloves disappeared once the participants become accustomed to the practice. However, post the trial, most participants went back to their previous habit of wearing single-gloves. Some possible reasons for this might be habit, training, style, and peer pressure.

Current Recommendations

Dr. Quebbeman recommends that if a patient has a known virus, tell the OR staff, and follow universal protection protocol. Chose safe equipment: laparoscopic techniques reduce exposure to sharps; electrocuttery and disposable scalpels decrease exposure; and staples prevent the frequent exposure to potential needle sticks during surgery; Proper technique includes: not using recapped needles; using forceps instead of fingers; avoiding instrument passing; and avoiding splashing during irrigation. Use safe practice to teach by example: check the adequacy of gowns, gloves and eye protection. Finally, make a habit of wearing double-gloves, especially when performing a long, complex procedure.

For professional correspondence, please contact Dr. Edward Quebbeman at equeb@mcw.edu.

Ortho Biotech

Funded through an unrestricted educational grant by Ortho Biotech.



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