From the Wake Forest Baptist Health (A.N.), Winston-Salem, North Carolina; University of Chicago (P.P.), Chicago, Illinois; University of Southern California (K.I., A.E.), Los Angeles, California; Temple University (Z.M., S.Y.), Philadelphia, Pennsylvania; University of California Los Angeles (D.Y.K., J.M.), Los Angeles, California; University of Maryland (W.C.C., B.D.), Baltimore, Maryland; Cooper University Health Care (J.P.H.), Camden, New Jersey; Loma Linda University (K.M., X.L.-O.), Loma Linda, California; Hennepin County Medical Center (R.M.N., A.P.M.), Minneapolis, Minnesota; Emory University (B.C.M., C.A.F.), Atlanta, Georgia; University of Alabama at Birmingham (P.L.B.), Birmingham, Alabama; Stony Brook University (R.S.J.), Stony Brook, New York; Oregon Health & Science University (S.E.R.), Portland, Oregon; University of Tennessee Health Science Center (L.J.M.), Memphis, Tennessee; Reading Hospital (A.W.O.), Reading, Pennsylvania; Boston Medical Center (T.S.B.), Boston, Massachusetts; Southside Hospital (M.D.G.), Bay Shore, New York; and University of Pennsylvania (M.J.S.), Philadelphia, Pennsylvania.
J Trauma Acute Care Surg. 2018 Jul;85(1):78-84. doi: 10.1097/TA.0000000000001940.
Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While human immunodeficiency virus/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1.9-18.0%) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures.
A prospective, observational study at 16 US trauma centers was performed (2015-2016). All bedside EDT resuscitation providers were surveyed with a standardized data collection tool and risk factors analyzed with respect to the primary end point, EDT occupational exposure (percutaneous injury, mucous membrane, open wound, or eye splash). Provider and patient variables and outcomes were evaluated with single and multivariable logistic regression analyses.
One thousand three hundred sixty participants (23% attending, 59% trainee, 11% nurse, 7% other) were surveyed after 305 EDTs (gunshot wound, 68%; prehospital cardiopulmonary resuscitation, 57%; emergency department signs of life, 37%), of which 15 patients survived (13 neurologically intact) their hospitalization. Overall, 22 occupational exposures were documented, resulting in an exposure rate of 7.2% (95% confidence interval [CI], 4.7-10.5%) per EDT and 1.6% (95% CI, 1.0-2.4%) per participant. No differences in trauma center level, number of participants, or hours worked were identified. Providers with exposures were primarily trainees (68%) with percutaneous injuries (86%) during the thoracotomy (73%). Full precautions were utilized in only 46% of exposed providers, while multiple variable logistic regression determined that each personal protective equipment item utilized during EDT correlated with a 34% decreased risk of occupational exposure (odds ratio, 0.66; 95% CI, 0.48-0.91; p = 0.010).
Our results suggest that the risk of occupational exposure should not deter providers from performing EDT. Despite the small risk of viral transmission, our data revealed practices that may place health care providers at unnecessary risk of occupational exposure. Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with personal protective equipment is paramount and would further minimize occupational exposure risks during EDT.
Therapeutic/care management study, level III.
职业暴露是急诊室开胸术（EDT）过程中需要考虑的一个重要因素。虽然已有报道称创伤患者中人类免疫缺陷病毒/肝炎的流行率（0-16.8%）和手术创伤过程中的职业暴露率（1.9-18.0%），但 EDTh 的暴露风险尚不清楚。我们假设 EDTh 的职业暴露风险大于其他手术创伤过程。
在 16 个美国创伤中心进行了一项前瞻性、观察性研究（2015-2016 年）。所有床边 EDTh 复苏提供者都使用标准化数据收集工具进行了调查，并针对主要终点 EDTh 职业暴露（经皮损伤、粘膜、开放性伤口或眼睛溅出）分析了危险因素。使用单变量和多变量逻辑回归分析评估了提供者和患者的变量和结果。
在 305 例 EDTh（枪伤，68%；院前心肺复苏，57%；急诊有生命迹象，37%）后，对 1360 名参与者（23%为主治医生，59%为学员，11%为护士，7%为其他）进行了调查，其中 15 名患者在住院期间存活（13 名神经功能完整）。总体而言，记录了 22 例职业暴露，导致每例 EDTh 的暴露率为 7.2%（95%置信区间 [CI]，4.7-10.5%），每例参与者的暴露率为 1.6%（95% CI，1.0-2.4%）。未发现创伤中心水平、参与者人数或工作时间存在差异。有暴露的提供者主要是学员（68%），在开胸术期间有经皮损伤（86%）。只有 46%的暴露提供者充分利用了个人防护设备，而多变量逻辑回归确定，EDTh 期间使用的每一项个人防护设备都与职业暴露风险降低 34%相关（优势比，0.66；95%CI，0.48-0.91；p=0.010）。
我们的研究结果表明，职业暴露的风险不应阻止提供者进行 EDTh。尽管病毒传播的风险很小，但我们的数据揭示了可能使医护人员面临不必要职业暴露风险的做法。无论该手术的救生性质如何，提高普遍预防措施并充分利用个人防护设备至关重要，这将进一步降低 EDTh 期间的职业暴露风险。
治疗/护理管理研究，III 级。
