Blood exposures in surgical practice: incidence, reporting rates, causation and prevention.

Little is known about the detailed circumstances of blood exposure incidents during surgery, but blood borne viruses can be transmitted via this route. This thesis describes a prospective study of 6096 consecutive surgical operations in a London teaching hospital. The incidence of blood exposures was measured and associated variables were identified. Blood exposures occurred in 2.4[percent] of operations. The risk was increased with major operations, long operations, and operations in which blood loss was greater than 500mls, the Renal team was operating or a qualified nurse was acting as 'scrub'. New findings were an increased risk when the main surgeon wore prescription glasses and when the wound was closed with staples. An additional study compared the main study data with two other methods of collecting blood exposure information, and estimated the rate of incident reporting by staff to the occupational health unit. Staff acknowledged the greatest number of blood exposure incidents when reporting retrospectively by confidential postal questionnaire. Only 15[percent] of the sharps exposures recorded on the postal questionnaire had been reported to the occupational health unit using the hospital routine reporting scheme. The final study compared Public Health Laboratory Service (PHLS) data on operations involved in transmission of hepatitis B virus from surgeon to patients with main study data. Operations in which hepatitis B transmission has been demonstrated were commonly performed operations in the hospital studied, but they did not have a high rate of blood exposure incidents. This thesis provides data that could be useful to guide efforts to reduce blood exposures during surgery. Several procedures at the study hospital have been revised in light of the findings. Areas that need further investigation include the circumstances in which staples are used, and the issue of performance of older surgeons, which has been debated recently. The results here suggest the possibility that a reduction of visual acuity may be associated with an increase in blood exposure incidents