Inadvertent prolonged fluid contact: an unappreciated professional risk for surgeons

Abstract

Sir, To avoid any blood or body ̄uid contact between a surgeon and his patient, surgical gloves and gowns have to constitute an unbroken sterile barrier. In operating room, the surgeon usually experiences needle-stick injury as a painful incident and instantaneously recognizes glove puncture: percutaneous blood exposure is authenticated but remains very brief. However, such a surgeon rarely spontaneously detects glove porosity, insensible glove micro puncture, or wet gown: these imperceptible incidents involve prolonged blood or body ̄uid cutaneous contact through unnoticed breaches in the surgeonpatient barrier. The integrity of this barrier can be well monitored using an electronic apparatus able to detect any abnormal ̄uid contact and to raise the alarm [1]. A prospective controlled study was performed during 80 randomly assigned to double or single gloving surgical procedures. Electronic detector (ElperÒ, Sofracob SA, Vienne, France) monitored surgeons during 238 hours and recorded 164 alarms. The surgeons only noticed 6 glove punctures, although 31 were electronically detected and con®rmed by postoperative glove examination. More signi®cantly, whereas the electronic device detected 57 ̄uid contacts authenticated as glove porosity and 76 ̄uid contacts authenticated as wet gown, surgeons never perceived any of them. Out of 164 detected barrier breakdowns, only 6 (3.6%) were spontaneously noticed by the surgeons [2]. In the absence of an electronic detector, the duration of inadvertent ̄uid contact that would have occurred from the time of the alarm to the end of the surgical procedure appears to be considerable. For 100 hours of operating time, a surgeon using single gloving would be in inadvertent ̄uid contact for 53 hours, but for only 29 hours when using double gloving (relative risk = 1.8, 95%CI: 1.3±2.5). The risk of viral transmission after prolonged cutaneous contaminating ̄uid contact is currently recognized [3]. Even so attempts to transmit bacteriophage through porous gloves had failed [4] and implied that the risk was minimal, unnoticed wet gowns and glove failures (including glove porosity) that involve channels large enough to permit the passage of many viruses [5] lead to potential viral contamination. The recent case of a professionally HIV contaminated surgeon who later transmitted HIV to a patient shows the disturbing reality of a two-way viral transmission through breaches in the aseptic barrier [6]. Surgical procedures should only be performed with double gloving, and companies should provide truly impermeable sterile single-use gowns. Currently, systematic electronic detection remains the only reliable method to alarm surgeons about inadvertent exposure to potentially contaminated body ̄uids.

DOI: 10.1023/A:1007690813508

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@article{Caillot2000InadvertentPF, title={Inadvertent prolonged fluid contact: an unappreciated professional risk for surgeons}, author={J L Caillot and Claire M. C{\^o}te and Eric J. Voiglio and Jacques Fabry}, journal={European Journal of Epidemiology}, year={2000}, volume={16}, pages={687-687} }