title: Surgeon-patient barrier efficiency monitored with an electronic device in three surgical settings.
abstract: Blood-borne viral pathogens are an occupational threat to health care workers (HCWs), particularly those in the operating room. A major risk is posed by accidental penetrating injury, but skin contamination with body fluids from an infected patient, with prolonged intimate cutaneous contact, is a frequent occurrence during surgery, carrying further risk of transdermal infection. We have monitored barrier failure in three surgical settings (microsurgery, orthopedic surgery, general surgery) by means of an electronic surveillance device. A total of 111 surgical procedures were monitored: 67 microsurgeries, 22 orthopedic surgeries, and 22 general surgeries. Of the 278 electronic alarms signaling barrier failure, 44 (15.8%) were associated with glove perforation, 39 of which (88.6%) were not perceived by the operator. In 16 of those, the skin was visibly stained with the patient's blood. Altogether, 76 of the alarms (27.3%) were consequent to contacts caused by soaked gowns/sleeves, and 121 (43.5%) were attributed to hydration of latex porosities; 37 alarms (13.4%) were unexplained false positives. On only one occasion did a surgeon observe blood stains on his hands without a previous alarm; this event was classified as a device failure due to incorrect wiring. Double-gloving offered satisfactory protection against skin contamination during microsurgery but not during orthopedic surgery. The data presented here indicate that electronic monitoring of the surgical barrier enables prompt detection of barrier failure, especially at the level of the gloves, thereby limiting skin contamination with patients' body fluids during surgery.
authors.affiliation: Department of Surgery, Division of Hand Surgery, Stanford University Medical Center, 300 Pasteur Drive, M121, Stanford, California 94305-5119, USA.
authors.forename: V R
authors.initials: VR
authors.lastname: Hentz
authors.forename: M
authors.initials: M
authors.lastname: Stephanides
authors.forename: A
authors.initials: A
authors.lastname: Boraldi
authors.forename: R
authors.initials: R
authors.lastname: Tessari
authors.forename: R
authors.initials: R
authors.lastname: Isani
authors.forename: R
authors.initials: R
authors.lastname: Cadossi
authors.forename: R
authors.initials: R
authors.lastname: Biscione
authors.forename: L
authors.initials: L
authors.lastname: Massari
authors.forename: G C
authors.initials: GC
authors.lastname: Traina
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D017848:Blood-Borne Pathogens; D004582:Electronics, Medical / Q000295:instrumentation*; D004867:Equipment Design / Q000295:instrumentation; D004868:Equipment Failure; D005260:Female; D013502:General Surgery / Q000295:instrumentation*; D005932:Gloves, Surgical; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000517:prevention & control*; D011481:Protective Clothing; D013523:Surgical Equipment; D013997:Time Factors