Surgeon-patient barrier efficiency monitored with an electronic device in three surgical settings

Blood-borne viral pathogens are an occupational threat to health care worke rs (HCWs), particularly those in the operating room. A major risk is posed by accidental penetrating injury, but skin contamination with body fluids f rom an infected patient, with prolonged intimate cutaneous contact, is a fr equent occurrence during surgery, carrying further risk of transdermal infe ction. We have monitored barrier failure in three surgical settings (micros urgery, orthopedic surgery, general surgery) by means of an electronic surv eillance device. A total of 111 surgical procedures were monitored: 67 micr osurgeries, 22 orthopedic surgeries, and 22 general surgeries. Of the 278 e lectronic alarms signaling barrier failure, 44 (15.8%) were associated with glove perforation, 39 of which (88.6%) were not perceived by the operator. In 16 of those, the skin was visibly stained with the patient's blood. Alt ogether, 76 of the alarms (27.3%) were consequent to contacts caused by soa ked gowns/sleeves; and 121 (43.5%) were attributed to hydration of latex po rosities; 37 alarms (13.4%) were unexplained false positives. On only one o ccasion did a surgeon observe blood stains on his hands without a previous alarm; this event was classified as a device failure due to incorrect wirin g. Double-gloving offered satisfactory protection against skin contaminatio n during microsurgery but not during orthopedic surgery. The data presented here indicate that electronic monitoring of the surgical barrier enables p rompt detection of barrier failure, especially at the level of the gloves, thereby limiting skin contamination with patients' body fluids during surge ry.