Blood-borne diseases pose a significant risk for healthcare workers, especially in operating rooms. There are several ways these diseases can be infected to the surgeon. Some of these ways are; Direct contamination such as contact with a pre-existing cut, glove damage, needle sticking and scalpel injury. There is another infection route that is indirect and especially encountered by orthopedic surgeons. This is blood, tissue and fat particles splashed on the users’ face (eye, mouth, nose) while drilling, cutting and reaming on the bone (Diseases Transmitted by Splashing). (Asef Alani et al., 2008)
The most dangerous viruses that can be infected to healthcare workers through blood; hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The anti-HBV vaccine has greatly reduced cases of HBV infection in healthcare workers since its releasing in 1981. (Lemaire R, Masson JB., 2000) There is almost no risk of infection in those who have completed the vaccination process and developed immunity (Centres for Disease Control and Prevention, 2003).
Despite this, there is still a significant prevalence (rate) of chronic HBV infection with a 6-30% risk of transmission from a single blood contact in susceptible individuals (Jaffray CE, Flint LM, 2003). The risks of HCV and HIV infection from a single blood contact are 1.8% and 0.3% respectively. The risk of HCV infection from mucocutaneous (related to mucous membrane and skin) contact is unknown. However, it has been reported that it is infected by splashing blood to the eyes (Centres for Disease Control and Prevention, 2003). HIV infection rate from mucocutaneous contact was measured as 0.1% and occupational infection by mucous membrane exposure has been reported (Lemaire R, Masson JB., 2000).
For healthcare professionals, the most effective way to prevent viruses that can be infected through blood is to prevent contact. Universal prevention measures recommended by the Centers for Disease Control and Prevention (CDC) are gloves, surgical aprons, masks, protective glasses and face shields. (Centres for Disease Control and Prevention, 2005)
Several studies have shown that the rates of compliance with universal measures (% 34 to 89.1) are variable. Not using masks and eye protection are the most common areas of inadequacy (Jaffray CE, Flint LM, 2003). Megan et al. (Patterson JM et al, 1998) made a survey that screened 768 surgeons’ views and their thoughts and practices on prevention from blood-borne viruses. They found that surgeons greatly underestimated the rates of HBV, HCV and HIV infection with exposure to infected blood and 88% had only mild-moderate concerns about blood-borne infections during surgery (Aisien AO, Ujah IA., 2006).
Asef Alani et al. (2008) conducted a study showing the amount of blood, fat and tissue fragments splashed to the face area in total knee and hip arthroplasty to reveal the hazard in orthopedic surgeries. This study, which includes surgeons, assistants and nurses, shows the splash areas of the fragments after 25 arthroplasty surgeries (11 hip, 14 knee surgeries) by placing a face template on the used protective visor. The results are as follows;
Table 1 . Total Knee Arthroplasty – The amount of blood, fat and tissue fragments which are splashed on the face (Asef Alani et al., 2008)
Table 2 . Total Hip Arthroplasty – The amount of blood, fat and tissue fragments which are splashed on the face (Asef Alani et al., 2008)
Power tools users may choose not to use a protective visor with considering the risk is low and for ease of application. But this study has revealed the sensitivity of the facial area and the importance of using protective visors in orthopedic surgeries. Today, all healthcare professionals use gloves, masks and visors in all their contact with patients within the scope of Covid-19 precautions. The important thing is that after the Covid-19 hazard has passed, our healthcare professionals must take the necessary precautions for their own safety.
Click here to reach more articles about body fluid splashes during surgery via PubMed.
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