Should eye protection be worn during dermatological surgery: prospective observational study

Birnie, AJ and Thomas, KS and Varma, S (2007) Should eye protection be worn during dermatological surgery: prospective observational study. British Journal of Dermatology, 156 . pp. 258-1262.

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Abstract

Background There is a potential risk of infection with blood-borne viruses if a doctor

receives a blood splash to a mucous membrane. The quantification of facial

contamination with blood has never been documented in the context of dermatological

surgery.

Objectives (i) To identify the number of facial blood splashes that occur during

skin surgery and to identify the procedures that present higher risks for the operator

and assistant. (ii) To assess the provision of eye protection and attitudes to

its use in dermatological surgery in the U.K.

Methods (i) Prospective, observational study in the skin surgery suite of a U.K.

teaching hospital assessing 100 consecutive dermatological surgery procedures,

plus 100 consecutive operations in which an assistant was present. Primary outcome:

number of face-mask visors with at least one blood splash. Secondary outcomes:

to identify if any of the following variables influenced the occurrence of

a blood splash: grade of operator, site and type of procedure, and the use of

electrocautery. (ii) A postal survey of all U.K.-based members of the British Society

of Dermatological Surgery (BSDS) was conducted assessing facilities available

and the attitudes of U.K.-based clinicians to the use of face masks during

surgery.

Results (i) In 33% of all surgical procedures there was at least one facial splash to

the operator (range 1–75) and in 15% of procedures the assistant received at

least one splash (range 1–11). Use of monopolar electrocautery was significantly

less likely to result in splashes to the mask compared with bipolar electrocautery

[odds ratio (OR) 0Æ04; 95% confidence interval (CI) 0Æ01–0Æ19]. Compared with

the head/neck, operations on the body were significantly more likely to result in

splashes to the mask (OR 6Æ52) (95% CI 1Æ7–25Æ07). The type of procedure and

the status of the operator did not have a bearing on the likelihood of receiving a

splash to the mask. (ii) From the survey, 33 of 159 (20Æ8%) of BSDS members

had no face masks available and 54 of 159 (34Æ0%) did not wear any facial protection

while operating. The majority (53Æ5%) thought they received a splash

in £ 1% of procedures.

Conclusions There is a substantial risk of a splash of blood coming into contact with

the face during dermatological surgery for both the operator and assistant,

regardless of the procedure. The risk of receiving a blood splash to the face may

be substantially underestimated by U.K.-based dermatologists. The use of protective

eyewear is advisable at all times, but particularly when using bipolar

electrocautery, or when operating on high-risk individuals.

Item Type: Article
Schools/Departments: University of Nottingham UK Campus > Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: attreed, karen
Date Deposited: 26 Mar 2008 15:11
Last Modified: 26 Mar 2008 15:11
URI: http://eprints.nottingham.ac.uk/id/eprint/875

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