Should eye protection be worn during dermatological surgery: prospective observational study

Birnie, A.J.; Thomas, K.S.; Varma, Sandeep

Abstract

Background There is a potential risk of infection with blood-borne viruses if a doctor receives a blood splash to a mucous membrane. The quantification of facial
contamination with blood has never been documented in the context of dermatological surgery.
Objectives (i) To identify the number of facial blood splashes that occur during skin surgery and to identify the procedures that present higher risks for the operator and assistant. (ii) To assess the provision of eye protection and attitudes to its use in dermatological surgery in the U.K.
Methods (i) Prospective, observational study in the skin surgery suite of a U.K. teaching hospital assessing 100 consecutive dermatological surgery procedures, plus 100 consecutive operations in which an assistant was present. Primary outcome:
number of face-mask visors with at least one blood splash. Secondary outcomes:
to identify if any of the following variables influenced the occurrence of
a blood splash: grade of operator, site and type of procedure, and the use of
electrocautery. (ii) A postal survey of all U.K.-based members of the British Society
of Dermatological Surgery (BSDS) was conducted assessing facilities available
and the attitudes of U.K.-based clinicians to the use of face masks during
surgery.
Results (i) In 33% of all surgical procedures there was at least one facial splash to
the operator (range 1–75) and in 15% of procedures the assistant received at
least one splash (range 1–11). Use of monopolar electrocautery was significantly
less likely to result in splashes to the mask compared with bipolar electrocautery
[odds ratio (OR) 0Æ04; 95% confidence interval (CI) 0Æ01–0Æ19]. Compared with
the head/neck, operations on the body were significantly more likely to result in splashes to the mask (OR 6Æ52) (95% CI 1Æ7–25Æ07). The type of procedure and
the status of the operator did not have a bearing on the likelihood of receiving a splash to the mask. (ii) From the survey, 33 of 159 (20Æ8%) of BSDS members had no face masks available and 54 of 159 (34Æ0%) did not wear any facial protection while operating. The majority (53Æ5%) thought they received a splash in £ 1% of procedures.
Conclusions There is a substantial risk of a splash of blood coming into contact with the face during dermatological surgery for both the operator and assistant,
regardless of the procedure. The risk of receiving a blood splash to the face may be substantially underestimated by U.K.-based dermatologists. The use of protective
eyewear is advisable at all times, but particularly when using bipolar electrocautery, or when operating on high-risk individuals.

Citation

Birnie, A., Thomas, K., & Varma, S. (2007). Should eye protection be worn during dermatological surgery: prospective observational study. British Journal of Dermatology, 156(6), https://doi.org/10.1111/j.1365-2133.2007.07930.x

• Journal Article Type: Article
• Acceptance Date: Dec 28, 2006
• Online Publication Date: May 23, 2007
• Publication Date: Jul 1, 2007
• Deposit Date: Mar 26, 2008
• Publicly Available Date: Mar 26, 2008
• Journal: British Journal of Dermatology
• Print ISSN: 0007-0963
• Electronic ISSN: 1365-2133
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 156
• Issue: 6
• DOI: https://doi.org/10.1111/j.1365-2133.2007.07930.x
• Public URL: https://nottingham-repository.worktribe.com/output/1016757
• Contract Date: Mar 26, 2008