title: Percutaneous and Mucocutaneous Exposure Among Orthopaedic Surgeons: Immediate Management and Compliance With CDC Protocol.
abstract: BACKGROUND
  Orthopaedic surgeons are at a high risk of sustaining a percutaneous or mucocutaneous exposure to blood and body fluids. The Center for Disease Control and Prevention recommends a wash with soap and water and notification of the concerned hospital authorities after any percutaneous/mucocutaneous exposure, but a systematic amenability with these guidelines is not always seen. This cross-sectional study was undertaken to determine current knowledge and practices of orthopaedic surgeons in case of a percutaneous sharp injury exposure, emphasizes the immediate first aid steps taken after an exposure, the degree of reporting, and to explore the reasons for noncompliance. Finally, we sought to create awareness about the prevailing Center for Disease Control and Prevention guidelines after any exposure to blood or body fluids.
  
  
  METHODS
  We conducted a cross-sectional survey using an anonymous prepared questionnaire. The study population included exclusively orthopaedic surgeons, including residents, fellows, and attending physicians at 4 US institutions. The questionnaire was also available online on the OTA Web site as a part of survey monkey. The questionnaire comprised 9 multiple choice questions, and more than 1 response could be given for some questions. The questions addressed previous needle stick/sharp injury exposure, number of times that had happened, whether reported to the hospital administration, reason for nonreporting, and risk perception for transmission of blood-borne pathogens (human immunodeficiency virus, HBsAg, and hepatitis C virus). The questions were also asked based on what should be done in four different clinical settings based on respondents risk perception.
  
  
  RESULTS
  Of fifty eight attendings, 7 fellows, 45 residents, and 7 respondents who did not indicate their position participated in the survey for a total of 117 respondents. Out of 99, 24 had sustained it once, 18 twice, 11 three times, and 35 at least 4 times. When questioned about informing the incident to the hospital administration, 38% had always reported the incident, 33% had never reported the incident, and the remaining 29% had not reported it every time. Of note, 87% gave the correct response about the risk of transmission of human immunodeficiency virus after an exposure. On questioning about the risk of hepatitis B transmission, from an HBsAg- and HBeAg-positive source, 13% gave the correct response, whereas from HBsAg-positive and HBeAg-negative source, 30% gave the correct response. Regarding transmission of hepatitis C virus from a positive source, 36% responded correctly. The surgeons seemingly attempted to risk stratify their exposure, and they were more likely to report their exposure in the higher risk scenarios.
  
  
  CONCLUSIONS
  This study demonstrates that orthopaedic surgeons of all levels of training are at high risk of occupational exposure to blood-borne pathogens. Moreover, despite the level of training, the majority of surgeons do not follow the recommended steps, although we do not know the reasons for such behavior. Also, there is a low awareness of the significant risk of hepatitis transmission among orthopaedic surgeons treating a population with a high prevalence of undiagnosed hepatitis.
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.
authors.forename: Hemil H
authors.initials: HH
authors.lastname: Maniar
authors.forename: Akhil A
authors.initials: AA
authors.lastname: Tawari
authors.forename: Michael
authors.initials: M
authors.lastname: Suk
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Bowen
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Horwitz
mesh_terms: D000328:Adult; D000368:Aged; D017848:Blood-Borne Pathogens; D002487:Centers for Disease Control and Prevention, U.S. / Q000592:standards; D004203:Disinfection / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control* / Q000706:statistics & numerical data; D008297:Male; D019221:Mandatory Reporting; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control / Q000706:statistics & numerical data; D060051:Occupational Injuries / Q000453:epidemiology / Q000628:therapy*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000592:standards*; D066231:Surgeons / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000628:therapy*