SKIN AND MUCOUS-MEMBRANE CONTACTS WITH BLOOD DURING SURGICAL-PROCEDURES - RISK AND PREVENTION

OBJECTIVE: To study the epidemiology and preventability of blood conta ct with skin and mucous membranes during surgical procedures. DESIGN: Observers present at 1,382 surgical procedures recorded information ab out the procedure, the personnel present, and the contacts that occurr ed. SETTING: Four US teaching hospitals during 1990. PARTICIPANTS: Ope rating room personnel in five surgical specialties. MAIN OUTCOME MEASU RES: Numbers and circumstances of contact between the patient's blood (or other infective fluids) and surgical personnel's mucous membranes (mucous membrane contacts) or skin (skin contacts, excluding percutane ous injuries). RESULTS: A total of 1,069 skin (including 620 hand, 258 body, and 172 face) and 32 mucous membrane (all affecting eyes) conta cts were observed. Surgeons sustained most contacts (19% had greater t han or equal to 1 skin contact and 0.5% had greater than or equal to 1 mucous membrane-eye contact). Hand contacts were 72% lower among surg eons who double gloved, and face contacts were prevented reliably by f ace shields. Mucous membrane-eye contacts were significantly less freq uent in surgeons wearing eyeglasses and were absent in surgeons wearin g goggles or face shields. Among surgeons, risk factors for skin conta ct depended on the area of contact: hand contacts were associated most closely with procedure duration (adjusted odds ratio [OR], 9.4; great er than or equal to 4 versus <1 hour); body contacts (arms, legs, and torso) with estimated blood losses (adjusted OR 8.4; greater than or e qual to 1,000 versus <100 mL); and face contacts, with orthopedic serv ice (adjusted OR 7.5 compared with general surgery). CONCLUSION: Skin and mucous membrane contacts are preventable by appropriate barrier pr ecautions, yet occur commonly during surgery. Surgeons who perform pro cedures similar to those included in this study should strongly consid er double gloving, changing gloves routinely during surgery, or both ( Infect Control Hosp Epidemiol 1995;16:703-711).