Eye splashes during invasive vascular procedures

Realigning the conventional routes of transmission: an improved model for occupational exposure assessment and infection prevention

Current recommendations for standard and transmission-based precautions in place for patients who are suspected or known to be infected or colonized with infectious agents are best suited to prevent the transfer of micro-organisms to other patients - that is, to prevent the acquisition of a healthcare-associated infection, rather than to protect the healthcare worker from self-contamination resulting in a potential occupationally acquired infection. This article reviews current recommended infection prevention and control practices and offers a framework for better protection and controls from an occupational health point of view. We offer a model with two exposure routes - contact and aerosol - resulting from work activities and environments, shifting the focus away from particular pathogenic micro-organisms' typical methods for spreading to patients or to other non-workers in hospital and community settings.

Eyewear contamination levels in the operating room: infection risk

We investigated eyewear contamination levels in the operating room to assess infection risk and inform protocol development. Microbial contamination after use was found in 37.7% of disposable and 94.9% of reusable eyewear pieces. After disinfection, 74.4% of reusable eyewear also cultured positive. Disposable eyewear may reduce intercase contamination risk. Reusable eyewear may carry ongoing bioburden and, thus, contribute to operating room environment risk. Eyewear with antimicrobial material or components could reduce risk. Alternative decontamination methods for reusable eyewear should be evaluated.

Reducing blood-borne exposure in interventional radiology: what the IR should know

Interventional radiologists are at risk of exposure to blood-borne pathogens in their day-to-day practice. Percutaneous exposure from unsafe sharps handling, mucocutaneous exposure from body fluid splashes, and glove perforation from excessive wear can expose the radiologist to potentially infectious material. The increasing prevalence of blood-borne pathogens, including hepatitis B and C, and human immunodeficiency virus, puts nurses, residents, fellows, and interventional radiologists at risk for occupational exposure. This review outlines suggestions to establish a culture of safety in the interventional suite.

Splash in elective primary knee and hip replacement: are we adequately protected?

An intra-operative splash is a common occurrence in elective knee and hip replacement surgery and can potentially transmit bloodborne diseases, with devastating consequences. This study aimed to quantify the risk of a splash and to assess its correlation with body mass index, duration of surgery and the volume of lavage fluid used. Between December 2007 and April 2008, 62 consecutive patients (38 women, 24 men) undergoing an elective total knee or total hip replacement (TKR, THR) were recruited into the study (32 TKRs and 30 THRs) after appropriate consent. A splash occurred in all 62 cases. A THR had a slightly higher risk of a splash than a TKR, but this was not statistically significant (p = 0.27). The correlation between body mass index, duration of surgery and the amount of pulse lavage used with a splash was r = 0.013, (non-significant), r = 0.52, (significant) and r = 0.92 (highly significant), respectively. A high number of splashes are generated during a TKR and a THR. The simple visor mask fails to protect the surgeon, the assistant or the patient from the risk of a splash and reverse splash, respectively.

Hygiene precautions and the transmission of infections in radiology

Healthcare-associated infections are a critical challenge for the public health sector. Most are acquired through contact, predominantly with the hands of health care personnel. Hand hygiene, therefore, is the single most effective measure for preventing and controlling infectious diseases. Recently, cases of acute hepatitis C occurred in patients who had undergone contrast-enhanced computed tomography. This was probably related to inadequate handling by health care staff. Rigorous compliance with standard precautions is therefore compulsory even in radiology, a setting traditionally considered at low risk for the transmission of pathogens. Adherence to standard precautions is still poor and the persistence of inappropriate practices responsible for preventable incidents is very common in radiology, often owing to underestimation of risk. Radiology units must promote compliance with correct hand hygiene through appropriate education programmes and provision of adequate areas and hand hygiene products. The evidence base to support the use of alcohol-based hand rub is demonstrating that these formulations are effective in improving hand hygiene compliance and preventing infections.

Risk for eye splash injury during administration of intraocular injections: a study of retina specialists and fellows

OBJECTIVE

To evaluate the use of eye protection and frequency of eye splash events during intraocular injections as well as infection risk awareness among retina specialists and fellows in training.

METHODS

In a prospective survey of practicing retina specialists and retina fellows, frequency of use and type of eye protection employed during intraocular injections, frequency of eye splash occurrences, description of the eye splash event, number of procedures performed, and awareness of transconjunctival infection risk were investigated.

RESULTS

Sixty-four ophthalmologists responded to the questionnaire: 40 retina fellows and 24 retina specialists. The response rate was 100%. Twenty-five percent of the fellows and 33.3% of the specialists reported using eye protection, including corrective glasses, during all intraocular injections. Two of the retina fellows and none of the specialists used special forms of eye protection. Retina fellows had a mean +/- SD of 2.1 +/- 1.3 years experience and the specialists had a mean +/- SD of 10.4 +/- 6.7 years experience in performing intraocular injections. The mean number of injections +/- SD performed by the fellows and specialists was 23 +/- 14.6 and 35 +/- 11.9 per month, respectively. Twelve conjunctival or corneal splash occurrences were reported by six fellows and two retina specialists. Eleven splash events occurred due to reflux of fluid during administration of subconjunctival anesthetic injection, and one event occurred during an anterior chamber tap. Splash events were significantly more likely to occur during procedures performed by fellows, with a relative risk of 8.4 for unprotected procedures (P< 0.001, Fisher exact test). Most (87.5%) of the participants were aware of the risk for transconjunctival viral infection.

CONCLUSION

Special eye protection is seldom used during administration of intraocular injections. Although the risk for eye splash during administration of subconjunctival anesthetic before intraocular injections is relatively small, protective measures may be considered when treating high-risk patients.

Accidental blood exposure: risk and prevention in interventional radiology

There is a growing concern about the transmission of bloodborne pathogens during medical procedures among health care workers and patients. Over the last three decades, radiological services have undergone many changes with the introduction of new modalities. One of these new disciplines is interventional radiology (IR) which deals with procedures such as arteriography, image-guided biopsies, intravascular catheter insertions, angioplasty and stent placements. Despite these developments, the potential for accidental blood exposure and exposure to other infectious material continues to exist. Therefore, it is important for all radiologists who perform invasive procedures to observe specific recommendations for infection control. In this review, we look at the different policies for protection and universal standards on infection control.

Ocular contamination during lesional surgery—a hazard for the plastic surgeon

Protective glasses reduce the risk of transconjunctival virus transmission although this has never been characterised for local anaesthetic skin lesion surgery. This study investigated the use of, and need for, protective eyewear during Plastic Surgery and the surgeons' attitude to risk.

MATERIALS AND METHODS

Study 1. A multi-center questionnaire recorded the attitudes of Plastic Surgeons' regarding google use and ocular viral transmission. Study 2. A single surgeon performed local anaesthetic skin lesion surgery over 8 months whilst wearing clean goggles. After each procedure the goggles were inspected for macroscopic splashes ans a record made of whether the operator had been aware of the splash occurrence.

RESULTS

Study 1. There were 36 respondents to the questionnaire (response rate of 84%). All grades recognised the risk of conjunctival contamination but most respondents did not wear goggles. Respondents changed their behavior, however, in 'high risk' cases. Study 2. 143 procedures resulted in 42 splashes. The surgeon was only aware of the splash in 6 cases.

CONCLUSION

Despite widespread recognition of the importance of eye protection, goggle use is still infrequent. Our study stresses the frequency of potential splashes to the eye and need for routine use of goggles to prevent viral transmission.

Potential exposure to hepatitis C virus through accidental blood contact in interventional radiology

PURPOSE

To quantify the prevalence of accidental blood exposure (ABE) among interventional radiologists and contrast that with the prevalence of patients with hepatitis C virus (HCV) undergoing interventional radiology procedures.

MATERIALS AND METHODS

A multicenter epidemiologic study was conducted in radiology wards in France. The risk of ABE to radiologists was assessed based on personal interviews that determined the frequency and type of ABE and the use of standard protective barriers. Patients who underwent invasive procedures underwent prospective sampling for HCV serologic analysis. HCV viremia was measured in patients who tested positive for HCV.

RESULTS

Of the 77 radiologists who participated in 11 interventional radiology wards, 44% reported at least one incident of mucous membrane blood exposure and 52% reported at least one percutaneous injury since the beginning of their occupational activity. Compliance with standard precautions was poor, especially for the use of protective clothes and safety material. Overall, 91 of 944 treated patients (9.7%) tested positive for HCV during the study period, of whom 90.1% had positive viremia results, demonstrating a high potential for contamination through blood contacts.

CONCLUSIONS

The probability of HCV transmission from contact with contaminated blood after percutaneous injury ranged from 0.013 to 0.030; the high frequency of accidental blood exposure and high percentage of patients with HCV could generate a risk of exposure to HCV for radiologists who perform invasive procedures with frequent blood contact. The need to reinforce compliance with standard hygiene precautions is becoming crucial for medical and technical personnel working in these wards.

The risk of eye splash injuries in surgery

BACKGROUND

This study arose out of a concern about the transmission of infectious diseases through eye splash injuries in surgery. The purpose of this study was to identify the extent of the risk of eye splash injuries.

METHODS

A prospective trial was undertaken which examined 160 consecutive eye shields used by surgeons and assistants in operations of 30 min or longer. The shields were inspected for macroscopic splashes and then tested for microscopic splashes using reagent strips.

RESULTS

Of the 160 eye shields used in surgery, 71 tested positive for blood (44%). The surgeon was aware of a spray episode in only 13 cases (8%). The splashes were macroscopically visible in only 26 (16%) cases. The risk of eye splash was higher for the surgeon than for the assistants and increased with the length of the operation.

CONCLUSIONS

This study demonstrates that the risk of eye splash injury in surgery is much greater than that perceived by most surgeons and trainees. Eye protection should be mandatory for all personnel in the operating theatre, particularly for those directly involved with the operation.

Bloodborne pathogens and procedure safety in interventional radiology

Concern about possible transmission of bloodborne pathogens during medical procedures is growing among patients and healthcare workers alike. This fear has primarily been focused on nosocomial transmission of human immunodeficiency virus (HIV), but other bloodborne infectious agents may also be transmitted during procedures. Chief among these are the hepatitis viruses, particularly hepatitis B virus (HBV) and hepatitis C virus (HCV), both of which are significantly more widespread than HIV. Although radiology is not traditionally thought of as a field with significant risk for exposure to or transmission of pathogens, the expanding role of interventional procedures in recent years belies that perception. The potential for exposure to blood or other possibly infectious material exists in virtually any invasive radiological procedure, from arteriography to image-guided biopsy. Fortunately, the risk of such exposure is low, and the risk of actual transmission of a bloodborne pathogen, whether from patient to healthcare worker or vice versa, is even lower. Nevertheless, it is important for all radiologists who perform invasive procedures to be aware of these risks and to observe pertinent safety and infection control recommendations. This article will review these topics.