Gerberding J L, Littell C, Tarkington A, Brown A, Schecter W P
Department of Medicine, University of California, San Francisco.
N Engl J Med. 1990 Jun 21;322(25):1788-93. doi: 10.1056/NEJM199006213222506.
We undertook an observational study of 1307 consecutive surgical procedures at San Francisco General Hospital to record descriptions of intraoperative exposures to blood and other body fluids, determine the factors predictive of these exposures, and identify interventions that might reduce their frequency. During a two-month period, circulating nurses took note of parenteral and cutaneous exposures to blood and recorded information about all procedures. In a follow-up validation study, 50 additional procedures were observed by the study investigators to determine the accuracy of the data collected by the nurses. A total of 960 gloves used by surgical personnel during the validation study were examined to determine the perforation rate. Accidental exposure to blood (parenteral or cutaneous) occurred during 84 procedures (6.4 percent; 95 percent confidence interval, 5.1 to 7.8 percent). Parenteral exposure occurred in 1.7 percent. The risk of exposure was highest when the procedures lasted more than three hours, when blood loss exceeded 300 ml, and when major vascular and intraabdominal gynecologic surgery was involved. Neither knowledge of diagnosed human immunodeficiency virus (HIV) infection nor awareness of a patient's high-risk status for such infection influenced the rate of exposure. Double gloving prevented perforations of the inner glove and cutaneous exposures of the hand. We conclude that all surgical personnel are at risk for intraoperative exposure to blood. Our data support the practice of double gloving and the increased use of water-proof garments and face shields to prevent mucocutaneous exposures to blood. No evidence was found to suggest that preoperative testing for HIV infection would reduce the frequency of accidental exposures to blood.
我们对旧金山综合医院连续进行的1307例外科手术进行了一项观察性研究，以记录术中接触血液和其他体液的情况描述，确定这些接触的预测因素，并确定可能降低其发生频率的干预措施。在为期两个月的时间里，巡回护士记录了非肠道和皮肤接触血液的情况，并记录了所有手术的相关信息。在一项后续验证研究中，研究人员又观察了50例手术，以确定护士收集数据的准确性。对验证研究期间外科人员使用的总共960只手套进行了检查，以确定穿孔率。在84例手术中发生了意外血液接触（非肠道或皮肤接触）（6.4%；95%置信区间为5.1%至7.8%）。非肠道接触发生率为1.7%。当手术持续时间超过三小时、失血量超过300毫升以及涉及大血管和腹腔内妇科手术时，接触风险最高。对已诊断的人类免疫缺陷病毒（HIV）感染的了解以及对患者此类感染高风险状态的知晓均未影响接触率。双层手套可防止内层手套穿孔和手部皮肤接触。我们得出结论，所有外科人员在术中都有接触血液的风险。我们的数据支持双层手套的做法以及增加使用防水服装和面罩以防止黏膜皮肤接触血液。未发现证据表明术前进行HIV感染检测会降低意外血液接触的频率。
