Tokars J I, Culver D H, Mendelson M H, Sloan E P, Farber B F, Fligner D J, Chamberland M E, Marcus R, McKibben P S, Bell D M
Hospital Infections Program, National Center for Infectious Diseases, Atlanta, Georgia 30333, USA.
Infect Control Hosp Epidemiol. 1995 Dec;16(12):703-11. doi: 10.1086/647044.
To study the epidemiology and preventability of blood contact with skin and mucous membranes during surgical procedures.
Observers present at 1,382 surgical procedures recorded information about the procedure, the personnel present, and the contacts that occurred.
Four US teaching hospitals during 1990.
Operating room personnel in five surgical specialties.
Numbers and circumstances of contact between the patient's blood (or other infective fluids) and surgical personnel's mucous membranes (mucous membrane contacts) or skin (skin contacts, excluding percutaneous injuries).
A total of 1,069 skin (including 620 hand, 258 body, and 172 face) and 32 mucous membrane (all affecting eyes) contacts were observed. Surgeons sustained most contacts (19% had > or = 1 skin contact and 0.5% had > or = 1 mucous membrane-eye contact). Hand contacts were 72% lower among surgeons who double gloved, and face contacts were prevented reliably by face shields. Mucous membrane-eye contacts were significantly less frequent in surgeons wearing eyeglasses and were absent in surgeons wearing goggles or face shields. Among surgeons, risk factors for skin contact depended on the area of contact: hand contacts were associated most closely with procedure duration (adjusted odds ratio [OR], 9.4; > or = 4 versus < 1 hour); body contacts (arms, legs, and torso) with estimated blood losses (adjusted OR, 8.4; > or = 1,000 versus < 100 mL); and face contacts, with orthopedic service (adjusted OR, 7.5 compared with general surgery).
Skin and mucous membrane contacts are preventable by appropriate barrier precautions, yet occur commonly during surgery. Surgeons who perform procedures similar to those included in this study should strongly consider double gloving, changing gloves routinely during surgery, or both.
研究手术过程中血液与皮肤及黏膜接触的流行病学情况及可预防性。
1382例手术的在场观察者记录了手术过程、在场人员及发生的接触情况。
1990年美国的四家教学医院。
五个外科专业的手术室人员。
患者血液（或其他感染性液体）与手术人员黏膜（黏膜接触）或皮肤（皮肤接触，不包括经皮损伤）之间接触的数量及情况。
共观察到1069次皮肤接触（包括620次手部、258次身体和172次面部接触）和32次黏膜接触（均累及眼睛）。外科医生接触最多（19%有≥1次皮肤接触，0.5%有≥1次黏膜-眼睛接触）。戴双层手套的外科医生手部接触减少72%，面罩能可靠预防面部接触。戴眼镜的外科医生黏膜-眼睛接触明显较少，戴护目镜或面罩的外科医生则无此类接触。在外科医生中，皮肤接触的危险因素取决于接触部位：手部接触与手术时间密切相关（调整优势比[OR]，9.4；≥4小时对比<1小时）；身体接触（手臂、腿部和躯干）与估计失血量相关（调整OR，8.4；≥1000毫升对比<100毫升）；面部接触与骨科手术相关（调整OR，与普通外科相比为7.5）。
通过适当的屏障预防措施可预防皮肤和黏膜接触，但手术期间此类接触仍很常见。进行与本研究中类似手术的外科医生应强烈考虑戴双层手套、在手术期间常规更换手套或两者兼用。
