Abstract
OBJECTIVE: To determine how often surgeons use strategies to prevent the transmission of bloodborne diseases and what factors are associated with the use of these strategies. DESIGN: Cross-sectional mail survey. SETTING: Secondary and tertiary care teaching hospitals affiliated with the University of Toronto. PARTICIPANTS: Of 539 active surgical staff and residents who were eligible, 503 (93.3%) responded. OUTCOME MEASURES: Current preventive practices, attitudes toward transmission of bloodborne diseases, perceived risk of infection and willingness to adopt preventive strategies. RESULTS: On average, surgeons reported using double- or triple-gloving in 32.2% of procedures, facial protection (including regular corrective eyewear) in 74.2% and goggles or face shields in 19.4%. Use of strategies to prevent sharp injuries, in addition to barrier precautions, was reported by 259 (51.5%) of the respondents. Factors associated with greater use of preventive strategies included resident position, subspecialty, greater number of years in surgical practice and a high perceived risk. Most of the respondents thought that patients should be routinely screened for HIV antibodies before surgery (68.2% [343/503]), that there was too little research into ways to reduce the risk of transmission of bloodborne diseases (55.3% [278/503]) and that there was too little effort on the part of organizations to reduce the risk of transmission (58.8% [296/503]). The perceived lifetime risk was reported to be moderate or high by 191 (38.0%) of the respondents and low or insignificant by 308 (61.2%). In all, 463 (92.0%) indicated a willingness to change the way they performed surgery to prevent transmission of bloodborne diseases. CONCLUSION: Surgeons expressed varying degrees of concern about the transmission of bloodborne diseases and reported infrequent use of preventive strategies. Efforts to reduce the risk of transmission between patients and surgeons will need to include informing surgeons of their personal risk and the availability of preventive strategies, improving the comfort of barrier precautions and minimizing how preventive strategies interfere with surgery.
Full text
PDF






Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aoun H., Aoun P. Issues raised by the possible transmission of HIV from a dentist to a patient. N Engl J Med. 1991 Jan 24;324(4):265–266. doi: 10.1056/NEJM199101243240412. [DOI] [PubMed] [Google Scholar]
- Bell D. M. Human immunodeficiency virus transmission in health care settings: risk and risk reduction. Am J Med. 1991 Sep 16;91(3B):294S–300S. doi: 10.1016/0002-9343(91)90385-b. [DOI] [PubMed] [Google Scholar]
- Bell D. M., Shapiro C. N., Culver D. H., Martone W. J., Curran J. W., Hughes J. M. Risk of hepatitis B and human immunodeficiency virus transmission to a patient from an infected surgeon due to percutaneous injury during an invasive procedure: estimates based on a model. Infect Agents Dis. 1992 Oct;1(5):263–269. [PubMed] [Google Scholar]
- Bessinger C. D., Jr Preventing transmission of human immunodeficiency virus during operations. Surg Gynecol Obstet. 1988 Oct;167(4):287–289. [PubMed] [Google Scholar]
- Brennan T. A. Transmission of the human immunodeficiency virus in the health care setting--time for action. N Engl J Med. 1991 May 23;324(21):1504–1509. doi: 10.1056/NEJM199105233242112. [DOI] [PubMed] [Google Scholar]
- Cohn G. M., Seifer D. B. Blood exposure in single versus double gloving during pelvic surgery. Am J Obstet Gynecol. 1990 Mar;162(3):715–717. doi: 10.1016/0002-9378(90)90992-g. [DOI] [PubMed] [Google Scholar]
- Durand E., Le Jeunne C., Hugues F. C. Failure of prophylactic zidovudine after suicidal self-inoculation of HIV-infected blood. N Engl J Med. 1991 Apr 11;324(15):1062–1062. doi: 10.1056/NEJM199104113241513. [DOI] [PubMed] [Google Scholar]
- Gerberding 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. 1990 Jun 21;322(25):1788–1793. doi: 10.1056/NEJM199006213222506. [DOI] [PubMed] [Google Scholar]
- Greco P. J., Eisenberg J. M. Changing physicians' practices. N Engl J Med. 1993 Oct 21;329(17):1271–1273. doi: 10.1056/NEJM199310213291714. [DOI] [PubMed] [Google Scholar]
- Hammond J. S., Eckes J. M., Gomez G. A., Cunningham D. N. HIV, trauma, and infection control: universal precautions are universally ignored. J Trauma. 1990 May;30(5):555–561. [PubMed] [Google Scholar]
- Lowenfels A. B., Wormser G. P., Jain R. Frequency of puncture injuries in surgeons and estimated risk of HIV infection. Arch Surg. 1989 Nov;124(11):1284–1286. doi: 10.1001/archsurg.1989.01410110038007. [DOI] [PubMed] [Google Scholar]
- Marcus R. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med. 1988 Oct 27;319(17):1118–1123. doi: 10.1056/NEJM198810273191703. [DOI] [PubMed] [Google Scholar]
- Matta H., Thompson A. M., Rainey J. B. Does wearing two pairs of gloves protect operating theatre staff from skin contamination? BMJ. 1988 Sep 3;297(6648):597–598. doi: 10.1136/bmj.297.6648.597. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McCue S. F., Berg E. W., Saunders E. A. Efficacy of double-gloving as a barrier to microbial contamination during total joint arthroplasty. J Bone Joint Surg Am. 1981 Jun;63(5):811–813. [PubMed] [Google Scholar]
- McKinney W. P., Young M. J. The cumulative probability of occupationally-acquired HIV infection: the risks of repeated exposures during a surgical career. Infect Control Hosp Epidemiol. 1990 May;11(5):243–247. doi: 10.1086/646161. [DOI] [PubMed] [Google Scholar]
- McLeod G. G. Needlestick injuries at operations for trauma. Are surgical gloves an effective barrier? J Bone Joint Surg Br. 1989 May;71(3):489–491. doi: 10.1302/0301-620X.71B3.2722946. [DOI] [PubMed] [Google Scholar]
- 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. JAMA. 1991 Mar 27;265(12):1533–1537. [PubMed] [Google Scholar]
- Rhame F. S. The HIV-infected surgeon. JAMA. 1990 Jul 25;264(4):507–508. [PubMed] [Google Scholar]
- Sacks H. S., Rose D. N. Zidovudine prophylaxis for needlestick exposure to human immunodeficiency virus: a decision analysis. J Gen Intern Med. 1990 Mar-Apr;5(2):132–137. doi: 10.1007/BF02600514. [DOI] [PubMed] [Google Scholar]
- Wright J. G., McGeer A. J., Chyatte D., Ransohoff D. F. Exposure rates to patients' blood for surgical personnel. Surgery. 1993 Nov;114(5):897–901. [PubMed] [Google Scholar]
- Wright J. G., McGeer A. J., Chyatte D., Ransohoff D. F. Mechanisms of glove tears and sharp injuries among surgical personnel. JAMA. 1991 Sep 25;266(12):1668–1671. [PubMed] [Google Scholar]
- Wright J. G., McGeer A. Human immunodeficiency virus transmission between surgeons and patients in orthopaedic surgery. Clin Orthop Relat Res. 1993 Dec;(297):272–281. [PubMed] [Google Scholar]
- Wright J. G., Singer P. A. HIV-seropositive surgeons: informed consent and public health policy. CMAJ. 1992 Jul 1;147(1):29–31. [PMC free article] [PubMed] [Google Scholar]
