Birnie A J, Thomas K S, Varma S
Department of Dermatology, Queen's Medical Centre, Nottingham, UK.
Br J Dermatol. 2007 Jun;156(6):1258-62. doi: 10.1111/j.1365-2133.2007.07930.x.
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.
(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.
(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.
number of face-mask visors with at least one blood splash.
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.
(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) 0.04; 95% confidence interval (CI) 0.01-0.19]. Compared with the head/neck, operations on the body were significantly more likely to result in splashes to the mask (OR 6.52) (95% CI 1.7-25.07). 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 (20.8%) of BSDS members had no face masks available and 54 of 159 (34.0%) did not wear any facial protection while operating. The majority (53.5%) thought they received a splash in <or= 1% of procedures.
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.
如果医生的黏膜接触到溅出的血液，就存在感染血源性病原体的潜在风险。在皮肤科手术中，面部血液污染的量化情况从未有过记录。
（i）确定皮肤手术过程中面部溅血的次数，并确定对手术医生和助手风险较高的手术操作。（ii）评估英国皮肤科手术中眼部防护用品的配备情况及其使用态度。
（i）在英国一家教学医院的皮肤手术室进行前瞻性观察研究，评估连续100例皮肤科手术，以及另外连续100例有助手参与的手术。
至少有一处溅血的面罩护目镜数量。
确定以下变量是否会影响溅血的发生：手术医生级别、手术部位和类型以及是否使用电灼术。（ii）对英国皮肤科外科学会（BSDS）所有英国会员进行邮寄调查，评估可用设施以及英国临床医生在手术中对面罩使用的态度。
（i）在所有手术中，33%的手术医生面部至少有一处溅血（范围为1 - 75处），15%的手术中助手至少有一处溅血（范围为1 - 11处）。与双极电灼术相比，使用单极电灼术导致面罩溅血的可能性显著降低[比值比（OR）0.04；95%置信区间（CI）0.01 - 0.19]。与头颈部手术相比，身体部位的手术导致面罩溅血的可能性显著更高（OR 6.52）（95% CI 1.7 - 25.07）。手术类型和手术医生级别与面罩溅血的可能性无关。（ii）在调查中，159名BSDS会员中有33名（20.8%）没有面罩，159名中有54名（34.0%）在手术时未佩戴任何面部防护用品。大多数人（53.5%）认为他们在≤1%的手术中会溅到血。
在皮肤科手术中，无论进行何种手术，手术医生和助手的面部都有很大风险接触到溅出的血液。英国皮肤科医生可能严重低估了面部溅血的风险。建议始终佩戴防护眼镜，尤其是在使用双极电灼术时，或对高危患者进行手术时。
