Advertisement

World Journal of Surgery

, Volume 25, Issue 9, pp 1101–1108 | Cite as

Surgeon-patient barrier efficiency monitored with an electronic device in three surgical settings

  • Vincent R. Hentz
  • Michael Stephanides
  • Attilio Boraldi
  • Renato Tessari
  • Riccardo Isani
  • Ruggero Cadossi
  • Roberto Biscione
  • Leo Massari
  • GianCarlo Traina
Original Scientific Reports

Abstract

Blood-borne viral pathogens are an occupational threat to health care workers (HCWs), particularly those in the operating room. A major risk is posed by accidental penetrating injury, but skin contamination with body fluids from an infected patient, with prolonged intimate cutaneous contact, is a frequent occurrence during surgery, carrying further risk of transdermal infection. We have monitored barrier failure in three surgical settings (microsurgery, orthopedic surgery, general surgery) by means of an electronic surveillance device. A total of 111 surgical procedures were monitored: 67 microsurgeries, 22 orthopedic surgeries, and 22 general surgeries. Of the 278 electronic alarms signaling barrier failure, 44 (15.8%) were associated with glove perforation, 39 of which (88.6%) were not perceived by the operator. In 16 of those, the skin was visibly stained with the patient’s blood. Altogether, 76 of the alarms (27.3%) were consequent to contacts caused by soaked gowns/sleeves, and 121 (43.5%) were attributed to hydration of latex porosities; 37 alarms (13.4%) were unexplained false positives. On only one occasion did a surgeon observe blood stains on his hands without a previous alarm; this event was classified as a device failure due to incorrect wiring. Doublegloving offered satisfactory protection against skin contamination during microsurgery but not during orthopedic surgery. The data presented here indicate that electronic monitoring of the surgical barrier enables prompt detection of barrier failure, especially at the level of the gloves, thereby limiting skin contamination with patients’ body fluids during surgery.

Keywords

Electronic Monitoring Latex Glove Sharp Injury Glove Perforation Prompt Detection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

La présence de virus pathogènes dans la circulation sanguine des patients constitue un risque permanent pour le personnel médical, en particulier, pour ceux qui travaillent en chirurgie. Un des risques majeurs est représenté par la piqûre cutanée accidentelle. La contamination de la peau par des fluides provenant des patients infectés, avec un contact cutané prolongé, est également un phénomène fréquent en chirurgie, avec un risque supplémentaire d’infection transdermique. Nous avons monitoré l’insuffisance de la protection dans trois situations différentes (microchirurgie, chirurgie orthopédique, chirurgie générale) par un appareil de surveillance électronique. Au total, on a monitoré 111 procédés chirurgicaux, 67 en microchirurgie, 22 en orthopédie et 22 en chirurgie générale. Des 278 alarmes électroniques signalant un échec au niveau d’une «barrière», 44 (15.8%) concernaient une perforation de gants, 39 des quelles (88.6%) n’étaient pas reconnues par l’opérateur. Dans 16 cas, la peau du chirurgien était manifestement tachée de sang. Soixante-seize signaux d’alarmes (27.3%) étaient consécutifs aux contacts en rapport avec des casaques et des manches de casaques trempés par du sang, et 121 (43.5%) étaient en rapport avec l’hydratation des porosités du latex. Dans 37 cas (13.4%) on n’a eu aucune explication: il s’agissait de faux positifs. Dans un seul cas, le chirurgien a observé des taches de sang sur ses mains, sans que l’alarme ne soit donné; cet évènement a été classé comme un défaut de fonctionnement en rapport avec un défaut du circuit électrique. Porter deux paires de gants a été d’une protection satisfaisante contre la contamination de la peau pendant la microchirurgie, mais pas pendant la chirurgie orthopédique. Les données présentées ici indiquent que le monitorage électronique de la barrière chirurgicale permet de détecter immédiatement des problèmes à ce niveau, surtout au niveau des gants, éliminant ainsi la contamination de la peau, par des fluides provenant des patients pendant la chirurgie.

Resumen

Agentes virales patógenos, transmisibles por vía hemática, constituyen una amenaza real para los trabajadores de la Salud, especialmente para aquellos que se dedican a la Cirugía. El riesgo mayor viene dado por heridas penetrantes accidentales, pero el contacto íntimo, prolongado de la piel con fluidos, como es frecuente en cirugía, conlleva el riesgo de sufrir una infección transdérmica. Mediante un dispositivo electrónico de vigilancia, monitorizando las barreras quirúrgicas para detectar posibles fallos de las mismas, se estudian tres tipos diferentes de cirugía (microcirugía, cirugía ortopédica y cirugía general). En total se monitorizaron 111 procedimientos quirúrgicos de los que 67 correspondieron a intervenciones microquirúrgicas, 22 a cirugía ortopédica y otros 22 a cirugía general. De las 278 alarmas electrónicas que señalaron un fallo de las barreras quirúrgicas, 44 (15.8%) se debieron a perforaciones de los guantes, que en 39 (88.6%) casos pasaron desapercibidas para el cirujano a pesar de que en 16, la piel estaba visiblemente manchada con sangre del paciente. 72 (27.3%) alarmas se dispararon como consecuencia del contacto del dispositivo electrónico de vigilancia con batas o mangas mojadas y 121 alarmas (43.5%) se atribuyeron a la hidratación de las porosidades del latex. En 37 (13.4%) casos, saltó inexplicablemente la alarma por lo que fueron considerados como falsos positivos. En un solo caso el cirujano constató manchas de sangre en la piel de sus manos sin que sonase el dispositivo de alarma; este hecho se atribuyó a un fallo en la instalación del dispositivo electrónico de vigilancia. El empleo de guantes dobles protege satisfactoriamente por lo que a la contaminación se refiere, durante una intervención microquirúrgica, pero son insuficientes en cirugia ortopédica. Los hallazgos de este estudio indican que la vigilancia monitorizada electrónica de la barrera quirúrgica, permite la detección instantánea de cualquier fallo de la misma, especialmente por lo que a los guantes se refiere. Se limita así, durante el acto quirúrgico, la contaminación de la piel con fluidos corporales del paciente.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Owens, D.K., Nease, R.F.: Occupational exposure to human immunodeficiency virus and hepatitis B virus: a comparative analysis of risk. Am. J. Med.92:503, 1997CrossRefGoogle Scholar
  2. 2.
    Perugia, L., Traina, G.C.: Current concept: AIDS and surgery. Int. Orthop.18:397, 1994PubMedCrossRefGoogle Scholar
  3. 3.
    Bell, D.M.: Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am. J. Med.102(5B):9, 1997PubMedCrossRefGoogle Scholar
  4. 4.
    Joint working party of the Hospital Infection Society and the Surgical Infection Study Group: Risks to surgeons and patients from HIV and hepatitis: guidelines on precautions and management of exposure to blood or body fluids. B.M.J.305:1337, 1992CrossRefGoogle Scholar
  5. 5.
    Puro, V., Petrosillo, N., Ippolito, G.: Risk of hepatitis C seroconversion after occupational exposures in health care workers: Italian Study Group on Occupational Risk of HIV and Other Bloodborne Infections. Am. J. Infect. Control23:273, 1995PubMedCrossRefGoogle Scholar
  6. 6.
    Palmer, J.D., Rickett, W.S.: The mechanisms and risks of surgical glove perforation. J. Hosp. Infect.22:279, 1992PubMedCrossRefGoogle Scholar
  7. 7.
    Fahey, B.J., Koziol, D.E., Banks, S.M., Henderson, D.K.: Frequency of nonparenteral occupational exposures to blood and body fluids before and after universal precautions training. Am. J. Med. Sci.90:145, 1991Google Scholar
  8. 8.
    Ippolito, G., Puro, V., De Carli, G.: The risk of occupational human immunodeficiency virus infection in health care workers. Arch. Intern. Med.153:1451, 1993PubMedCrossRefGoogle Scholar
  9. 9.
    Lot, F., Seguir, J.C., Fegueux, S., Astagneau, P., Simon, P., Aggoune, M.: Probable transmission of HIV from an orthopedic surgeon to a patient in France. Ann. Intern. Med.130:1, 1999PubMedGoogle Scholar
  10. 10.
    Brown, P.: Surgeon infects patient with hepatitis C. B.M.J.319:1219, 1999Google Scholar
  11. 11.
    Sánchez, L.P., Flynn, J.M., Mayol, M.: Seroprevalence of blood borne transmissible diseases in trauma orthopaedic surgical patients. P. R. Health Sci. J.2:113, 1998Google Scholar
  12. 12.
    Montecalvo, M.A., Lee, M.S., DePalma, H., Wynn, P.S., Lowenfels, A.B., Jorde, U., Wuest, D., Klingaman, A., O’Brien, T.A., Calmann, M., Wormser, G.: Seroprevalence of human immunodeficiency virus-1, hepatitis B virus, and hepatitis C virus in patients having major surgery. Infect. Control Hosp. Epidemiol.16:627, 1995PubMedCrossRefGoogle Scholar
  13. 13.
    Centers for Disease Control (USA): Guidelines for prevention of human immunodeficiency virus and hepatitis B virus to health-care and public safety workers. M.M.W.R. Morb. Mortal. Wkly. Rep.38:31, 1989Google Scholar
  14. 14.
    Quebbeman, E.J., Telford, G.L., Hubbard, S., Wadsworth, K., Hardman, B., Goodman, H., Gottlieb, M.S.: Risk of blood contamination and injury to operating room personnel. Ann. Surg.214:614, 1991PubMedCrossRefGoogle Scholar
  15. 15.
    Dodds, R.D.A., Guy, P.J., Peacock, A.M., Duffy, S.R., Barker, S.G.E., Thomas, M.H.: Surgical glove perforation. Br. J. Surg.75:966, 1988PubMedCrossRefGoogle Scholar
  16. 16.
    Geberding, J.L., Littell, C., Tarkington, A., Brown, A., Schecter, W.P.: Risk of exposure of surgical personnel to patients’ blood during surgery at San Francisco General Hospital. N. Engl. J. Med.322:1788, 1990CrossRefGoogle Scholar
  17. 17.
    Serrano, C.W., Wright, J.W., Newton, E.R.: Surgical glove perforation in obstetrics. Obstet. Gynecol.77:525, 1991PubMedGoogle Scholar
  18. 18.
    Sanders, R., Fortin, P., Ross, E., Helfet, D.: Outer gloves in orthopedic procedures. J. Bone Joint Surg. (Am.)72:914, 1990Google Scholar
  19. 19.
    Cole, R.P., Gault, D.T.: Glove perforation during plastic surgery. Br. J. Plast. Surg.42:481, 1989PubMedCrossRefGoogle Scholar
  20. 20.
    Hollaus, P.H., Lax, F., Jankiev, D., Wurnig, P.N., Pridun, N.S.: Glove perforation rate in open lung surgery. Eur. J. Cardio-thorac. Surg.15:461, 1999CrossRefGoogle Scholar
  21. 21.
    McLeod, G.G.: Needlestick injuries at operations for trauma: are surgical gloves an effective barrier? J. Bone Joint Surg. (Br.)71:489, 1989Google Scholar
  22. 22.
    Sim, A.J.W., Dudley, H.A.F.: Surgeons and HIV. B.M.J.296:80, 1988CrossRefGoogle Scholar
  23. 23.
    Wright, J.C., McGeer, A.J., Chyatte, D., Ransohoff, D.F.: Mechanisms of glove tears and sharp injuries among surgical personnel. J.A.M.A.266:1668, 1991PubMedCrossRefGoogle Scholar
  24. 24.
    Wright, J.C., McGeer, A.J., Chyatte, D., Ransohoff, D.F.: Exposure rates to patients’ blood for surgical personnel. Surgery114:897, 1993PubMedGoogle Scholar
  25. 25.
    Pietrabissa, A., Merigliano, S., Montorsi, M., Poggioli, G., Stella, M., Borzomati, D., Ciferri, E., Rossi, G., Doglietto, G.: Reducing the occupational risk of infections for the surgeon: multicentric national survey on more than 15,000 surgical procedures. World J. Surg.21: 573, 1997PubMedCrossRefGoogle Scholar
  26. 26.
    Godin, M.S., Lavernia, C.J., Harris, J.P.: Occult surgical glove perforations in otolaryngology-head and neck surgery. Arch. Otol. Head Neck Surg.117:910, 1991Google Scholar
  27. 27.
    Panlilio, A.L., Foy, D.R., Edwards, J.R., Bell, D.M., Welch, B.A., Parrish, C.M., Culver, D.H., Lowry, P.W., Jarvis, W.R., Perlino, C.A.: Blood contacts during surgical procedures. J.A.M.A.265:1533, 1991PubMedCrossRefGoogle Scholar
  28. 28.
    Smoot, E.C.: Practical precautions for avoiding sharp injuries and blood exposure. Plast. Reconstr. Surg.101:528, 1998PubMedCrossRefGoogle Scholar
  29. 29.
    Hamer, A.J.: Electronic device for the detection of breaches in asepsis during surgical procedures. Br. J. Surg.74:1038, 1978CrossRefGoogle Scholar
  30. 30.
    MacIntyre, I.M.C., Currie, J.S., Smith, D.N., Anderson, I.D., Cadossi, R.: Reducing the risk of viral transmission at operation by electronic monitoring of the surgeon-patient barrier. Br. J. Surg.81:1076, 1994PubMedCrossRefGoogle Scholar
  31. 31.
    Noera, G.: Blood contacts during open heart operations: reducing the risk. Ann. Thorac. Surg.57:785, 1994PubMedCrossRefGoogle Scholar
  32. 32.
    Eckford, S.D., James, M., Jackson, S.R., Hamer, A.J., Browning, J.J.: Detection of glove puncture and skin contamination during caesarian section. Br. J. Obstet. Gynaecol.104:1209, 1997PubMedCrossRefGoogle Scholar
  33. 33.
    Caillot, J-L., Côte, C., Abidi, H., Fabry, J.: Electronic evaluation of the value of double gloving. Br. J. Surg.86:1387, 1999PubMedCrossRefGoogle Scholar
  34. 34.
    Tucker, R.D., Ferguson, S.: Do surgical gloves protect staff during electrosurgical procedures? Surgery110:892, 1991PubMedGoogle Scholar
  35. 35.
    Hentz, V.R., Traina, G.C., Cadossi, R., Zucchini, P., Muglia, M.A., Giordani, M.: The protective efficacy of surgical latex gloves against the risk of skin contamination: how well are the operators protected? J. Mater. Sci. Mater. Med.12:825, 2000CrossRefGoogle Scholar
  36. 36.
    Matta, H., Thompson, A.M., Rainey, J.B.: Does wearing of two pairs of gloves protect theatre staff from contamination? B.M.J.297:597, 1988CrossRefGoogle Scholar
  37. 37.
    Novak, C.B., Patterson, J.M., Mackintosh, S.E.: Evaluation of hand sensibility with single and double latex gloves. Plast. Reconstr. Surg.103:128, 1999PubMedCrossRefGoogle Scholar
  38. 38.
    Blauvelt, A.: The role of skin dendritic cells in the initiation of human immunodeficiency virus infection. Am. J. Med.102(5B):16, 1997PubMedCrossRefGoogle Scholar
  39. 39.
    Reece, J.C., Handley, A.J., Anstee, E.J., Morrison, W.A., Crowe, S.M., Cameron, P.U.: HIV-1 selection by epidermal dendritic cells during transmission across human skin. J. Exp. Med.187:1623, 1998PubMedCrossRefGoogle Scholar

Copyright information

© Springer International 2001

Authors and Affiliations

  • Vincent R. Hentz
    • 1
  • Michael Stephanides
    • 1
  • Attilio Boraldi
    • 2
  • Renato Tessari
    • 2
  • Riccardo Isani
    • 3
  • Ruggero Cadossi
    • 3
  • Roberto Biscione
    • 4
  • Leo Massari
    • 4
  • GianCarlo Traina
    • 4
  1. 1.Department of Surgery, Division of Hand SurgeryStanford University Medical CenterStanfordUSA
  2. 2.Department of General SurgeryOspedale Civile di CarpiCarpiItaly
  3. 3.Research and Development DepartmentIgea S.r.l.CarpiItaly
  4. 4.Department of Orthopedic SurgeryArcispedale S. AnnaFerraraItaly

Personalised recommendations