title: Blood splash injury: an underestimated risk in endourology.
abstract: OBJECTIVE
  Mucocutaneous and transconjunctival exposure are important portals for the transmission of blood-borne infections to surgeons and health-care workers. Despite this knowledge, few surgeons or their assistants wear protective equipment for procedures perceived to be affiliated with less risk. This study investigates the potential risk of mucocutaneous and transconjunctival blood splash injury during common laparoscopic and endourologic procedures undertaken using standard video endoscopy equipment.
  
  
  METHODS
  Masks combined with eye shields were consecutively collected from the surgeon, surgical assistant, and theater nurse after a variety of endourologic procedures over a 4-month period. These were analyzed macroscopically for visible blood droplets. Modern forensic techniques were then instituted to assess for nonvisible blood exposure.
  
  
  RESULTS
  Eye shields from 118 procedures performed by five surgeons were collected. Two hundred and thirty-six masks were examined for visible and visually enhanced evidence of blood contamination. In total, 48.5% of surgeons' masks, 29.5% of assisting surgeons' masks, and 31.8% of scrub nurse masks were positive for either visible or visually enhanced blood contamination. In terms of evidence of blood splash, 84.2% of laparoscopic nephrectomies, 66.7% of pyeloplasties, and 58.3% of flexible ureteroscopies tested positive.
  
  
  CONCLUSIONS
  Splash injuries remain commonplace, even with the use of video endoscopy equipment. Therefore, all health-care workers should be encouraged to wear eye and face protection when undertaking both endoscopic and laparoscopic urologic procedures. These observations may have broader implications relevant to all minimally invasive surgical procedures, because they demonstrate a much greater potential risk of blood-borne disease transmission during surgery than has been previously appreciated.
authors.affiliation: Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, Scotland. mwines@tpg.com.au
authors.forename: Michael P
authors.initials: MP
authors.lastname: Wines
authors.forename: Alastair
authors.initials: A
authors.lastname: Lamb
authors.forename: Athanasios N
authors.initials: AN
authors.lastname: Argyropoulos
authors.forename: Alessandro
authors.initials: A
authors.lastname: Caviezel
authors.forename: C
authors.initials: C
authors.lastname: Gannicliffe
authors.forename: David
authors.initials: D
authors.lastname: Tolley
mesh_terms: D017848:Blood-Borne Pathogens; D005135:Eye Protective Devices; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D008397:Masks; D012307:Risk Factors; D013520:Urologic Surgical Procedures / Q000009:adverse effects*