title: Risk of ocular blood splatter during oculofacial plastic surgery.
abstract: OBJECTIVE
  To assess intraoperative blood splatter to the ocular surface and adnexa during oculofacial surgery.
  
  
  METHODS
  Four surgeons and multiple assistants at three separate locations wore a total of 331 protective eye shields during 131 surgeries. Postoperatively, a luminol blood detection system was used to identify blood splatter on the shields. In the event of positive blood splatter, the total number of blood spots was counted. Controls were used to verify the blood detection protocol. A postoperative questionnaire was given to all surgeons and assistants after each case, and they were asked whether intraoperative blood splatter was noticed.
  
  
  RESULTS
  Blood was detected on 61% of eye shields and in a total of 80% of surgical cases. However, only 2% of blood splatters were recognized intraoperatively by the surgical participants. There was no significant difference in the splatter rate between surgeons (64%), assistants (60%), and surgical technicians (58%) (p = 0.69). Shields worn during full-thickness eyelid procedures, direct brow lifting, orbitotomy with bony window, and orbital fracture repairs were more likely to be splattered (p = 0.03), and there was a significant difference between splatter rates among different surgeons (range, 29-90%; p = 0.0004), suggesting that blood splatter rate may be both procedure dependent and surgeon dependent.
  
  
  CONCLUSIONS
  Mucocutaneous and transconjunctival transmission of human immunodeficiency virus and viral hepatitis has been documented. These results suggest that oculofacial plastic surgeons should consider eye protection for patients with known blood-borne diseases and in cases where blood splatter is expected. This precautionary practice is supported by the high incidence (98%) of undetected, intraoperative blood splatter.
authors.affiliation: *Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; †Division of Ophthalmology, Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/Doctor's Hospital, Columbus, Ohio; ‡Department of Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, Ohio; and §Department of Ophthalmology, Loyola University Health System, Maywood, Illinois, U.S.A.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Stacey
authors.forename: Craig N
authors.initials: CN
authors.lastname: Czyz
authors.forename: Srinivas Sai A
authors.initials: SS
authors.lastname: Kondapalli
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hill
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Everman
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Cahill
authors.forename: Jill A
authors.initials: JA
authors.lastname: Foster
mesh_terms: D001769:Blood; D005135:Eye Protective Devices; D006801:Humans; D015994:Incidence; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D007431:Intraoperative Complications; D016273:Occupational Exposure / Q000009:adverse effects*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012307:Risk Factors; D013518:Surgery, Plastic / Q000009:adverse effects; D011795:Surveys and Questionnaires