Mucocutaneous exposure to body fluids during digestive endoscopy: the need for universal precautions.
BACKGROUND
Endoscopy personnel are at high risk of exposure to infectious body fluids during endoscopy. There are no studies documenting the frequency of such exposure.


OBJECTIVE
To determine the frequency of exposure to body fluids, and factors that may modify the risk of exposure during digestive endoscopy.


METHODS
During a 10-month period, 948 endoscopy procedures done by two endoscopists were assessed for the occurrence of splashes to uncovered parts of the body. Odds ratio was used to determine any change in the exposure risk with different risk factors.


RESULTS
The overall frequency of splash to any part of the body was 13.2% (95% CI 10.8-15.9). Common sites of exposure were the eyes, face, forearms and feet. Splash to the skin of the face, forearms and feet occurred in 9.5% (95% CI 7.5-11.8). The risk remained unchanged during therapeutic endoscopy, assisted endoscopy, or endoscopy with biopsy or cytology. Using video endoscopy led to significant reduction in splashes on the skin. Overall splash rate to the eyes was 4.1% (95% CI 2.9-5.6). This remained unchanged during therapeutic endoscopy, assisted endoscopy, and endoscopic biopsy or cytology sampling. The risk was not reduced during video endoscopy.


CONCLUSIONS
Endoscopy results in muco-cutaneous exposure to potentially infectious body fluids in 13% or more procedures. The risk of exposure is not reduced by video endoscopy, or by avoiding instrumentation of the biopsy channel. We recommend that all endoscopists and endoscopy assistants must follow universal precautions.
Mohandas
K M
KM
Division of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai. kmmohandas@vsnl.com
Gopalakrishnan
G
G
D001826:Body Fluids; D003141:Communicable Diseases / Q000635:transmission*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D009092:Mucous Membrane; D016273:Occupational Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D016635:Universal Precautions