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Operating room injuries to staff

 

Clinical bottom line

Injuries to operating room staff in 1000 consecutive operations in Switzerland amounted to at least one injury in 9.6% of emergency procedures, 6.6% of elective procedures and 1.1% of endoscopic procedures. The lifetime risk of HIV infection to a surgeon was 0.3%.


Reference

PC Cassina et al. The real incidence of percutaneous injuries in the operating room - a prospective study. Swiss Surgery 1999 5: 27-32.

Study

In this study in Zurich every percutaneous injury occurring in the operating room during 1000 consecutive procedures was studied during a four-month period in March 1995. A percutaneous injury was defined as a bleeding skin lesion following accidental contact with contaminated needles, blades or other sharp instruments leading to patient-to-professional contact with blood or body fluids.

Results

Overall there were 73 injuries in 1000 procedures (7.3%). Injuries to the surgeon occurred 35 times, to the assistant 18 times and to the scrub nurse 18 times. The injury rate according to different procedures is shown in Table 1.

Table 1: Percutaneous injury rate according to procedure

Procedure

Number

Injuries (%)

Elective

761

6.6

Emergency

239

9.6

Endoscopic

91

1.1

The most experienced surgeons had lower rates of injury.Injury rates according to surgical grade and type of procedure is shown in table 1.

Table 2: Percutaneous injury according to surgical experience

Level of experience

Elective (%)

Emergency (%)

House staff

5.1

3.3

Assistant

6.8

4.1

Head surgeon

1.7

1.3

The calculated lifetime transmission rate for HIV based on a population prevalence of 0.4%, and a lifetime workload of 7,500 procedures over a 30-year career was 0.3%.

Comment

This prospective study was carefully done. All the injuries occurred using sharp instruments or suture needles, and none mentioned use of a hollow bore needle.