Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 57, Num. 11, 2003, pp. 507

Indian Journal of Medical Sciences, Volume 57, Number 11, November 2003, pp. 507

Letter to editor

Facial and Body Blood Contamination in Minor Obstetrics and Gynecologic Surgeries

J B Sharma, A Gupta, M Malhotra

Department of Obstetrics and Gynecology, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi 110001, India.
E-mail: jbsharma@eth.net

Code Number: ms03040

Sir,

Healthcare professionals are at risk of acquiring viral diseases like hepatitis and human immunodeficiency virus (HIV) from contamination of skin, mucous membranes and conjunctiva with blood,^1-5 Obstetricians and midwives often face blood splashes and facial and body blood and amniotic fluid contamination.^1-4 The centre of disease control policy statement advises universal precautions for the avoidance of transmission of these diseases.⁷ But in actual clinical practice not many doctors comply with these guidelines.⁴ Wearing of goggles, gumboots and protective clothing is uncommon and even wearing masks is getting less common.² Although obstetricians and midwives are becoming aware of the risks of body blood contamination, gynecologic surgery is considered a low risk area.

We conducted a prospective on 120 minor surgeries (84 obstetric and 36 gynecologic surgeries) over a 4-month period from December 2001 to March 2002 to find out the incidence of blood splashes over different body parts of the obstetricians and their assistants. The data was compiled and analyzed using appropriate statistical methods (Chi-Square test with significance being fixed at 0.05).

The mean age of women was 24.2 years and 42.3 years, while mean parity was 2.3 and 3.4, in obstetric and gynecologic surgeries respectively. Among 84 obstetric surgeries, 44 (52.4%) women had medical termination of pregnancy, while 40 (47.6%) had surgery for early pregnancy complications. Among 36 gynecological surgeries, 23 were dilatation and curettage or fractional curettage, 7 were endocervical curettage or endometrial aspirate, 3 were endometrial biopsy and 3 were miscellaneous surgeries.

The overall body blood contamination rate was found to be significantly higher in surgeons than in assistants (54.2% vs. 32.6%; P=0.0022). The difference was similar in both obstetrical and gynecological procedures. Among the obstetrical procedures, the blood splash rate was found to be highest for MTP. This was found to be significantly higher over surgeons as well as assistants in MTP done for more than 10 weeks gestation as compared to less than 10 weeks gestation (100% and 84.6% versus 36.7% and 15.4%, respectively). The overall blood splash rate over the surgeon's versus assistant's masks, goggles, body and feet were 20% versus 12.5% (P< 0.05), 28.4% versus 2.6% (p< 0.01), 16.7% versus 3.4% (P<0.05), 40.9% versus 25.8% (P<0.01) respectively. The blood splash rate over the surgeon and assistant masks, goggles, body and feet in minor obstetric procedures was 23.8% and 14.9%, 30.4% and 3.5%, 21.4% and 4.5%, 50% and 32.8% respectively and was significantly higher than minor gynecologic procedures (P<0.05) where the rate was 11% and 4.6%, 24.2% and 0%, 5.6% and 0%, 19.4% and 4.6% respectively, in the surgeon and the assistant.

There is general feeling that midwifery practice is a high-risk specialty for exposure to blood and amniotic fluid contamination while gynecologic surgery is not that dangerous. But the results of the present study clearly demonstrates a very high incidence of blood splashes over surgeon and assistants masks, goggles, body and feet in minor gynecologic surgeries.

We feel minor gynecologic surgery is associated with a very high rate of facial and body blood contamination in surgeons and assistants putting them at high risk of acquiring viral disease. We recommend the use of masks, goggles, protective clothing and gumboots for all minor gynecologic surgeries especially in third world countries where the attitude of health care workers is relaxed towards their own safety due to excessive workload, and where the HIV and hepatitis status of most women undergoing minor gynecologic surgery is usually not known.

REFERENCES

1. Sharma JB, Ekoh S, McMillan L, Hussain S, Annan H. Blood splashes to the masks and goggles during caesarean section. Br J Obstet Gynaecol 1997;104:1405-6.

2. Sharma JB, Kumar A. Facial and body blood contamination in vaginal delivery. Int J Gynecol Obstet 2001;74:57-8.

3. Advisory Committee on Dangerous Pathogens (ACDP). Protection against blood borne infection in the workplace: HIV and Hepatitis. London: HMSO; 1995.

4. Centre for Disease control update. Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus and other blood borne pathogens in health care settings. MMWR 1998;37:377-83.

5. Titchenor JR, Miller RC, Wolf RC. Risks of eye splash in obstetric procedures. Am J Perinatol 1994;11:359-61.

6. Kouri DL, Ernest JM. Incidence of perceived and actual face shield contamination during vaginal and cesarean delivery. AM J Obstet gynecol 1993;169:312-6.

7. Sharma JB, Gupta A, Malhotra M, Arora R. Facial and body blood contamination in major gynecologic surgeries. J Obstet Gynaecol Res 2003;29:402-5.

Copyright 2003 - Indian Journal of Medical Sciences.