Acquisition of hepatitis C by a conjunctival splash

Oral and maxillofacial surgeons are occupationally exposed to ocular injuries via bodily fluid (ie, blood or saliva), which can carry substantial latent risks, both bacterial and viral. The aim of this study was to determine the prevalence of ocular injury and infection among oral and maxillofacial surgeons during outpatient procedures.

Data were collected from a consecutive series of 500 surgeries conducted by 26 resident surgeons via a questionnaire. Responses were categorized into two groups: Group I did not indicate an eye injury, and Group II did indicate an eye injury.

Of 500 procedures, 161 resulted in ocular injuries, a rate of 32.2 injuries per 100 person-procedures. Educated participants experienced eye injuries at a significantly higher rate than those who were uneducated (23.33% vs. 15.11%; P = 0.022). Those not using eye protection experienced eye injuries at a significantly higher rate than those using eye protection (23.32% vs. 2.33%; P < 0.001). Of all eye injuries, 14.28% required medical management. Incidents were reported at a rate of 10.56%, higher in those with multiple injuries.

These findings demonstrate major inadequacies and breaches of the present eye/face protection protocols. Because the number of clinical studies on ocular injuries during oral and maxillofacial surgerical procedures is limited in the literature, each additional study can be important for promoting awareness among professionals, so that serious morbidity can be prevented.

Orthopedic surgery residents are at risk for daily work-related hazards and exposures. Hazards related specific to this specialty includes radiation exposure, smoke inhalation (from electrocautery), and disease transmission through contact with surgical instruments or sharps during procedures. However, minimal research has been focused on other occupational hazard risks in orthopedic surgery including surgical splash events and workplace violence. This study focused on determining (1) whether or not use of protective eyewear in the workplace would be related to the availability of personal protective equipment (PPE); (2) resident education; and (3) the rate of workplace violence toward orthopedic surgery residents during their training.

An invitation to participate in a web-based, anonymous survey to 46 US allopathic orthopedic surgery residency programs (1207 potential resident respondents). The survey was conceptually divided into the following areas: (1) demographics; (2) training and attitudes concerning occupational hazards; (3) PPE provision and use; (4) sharps injuries and reporting; and (5) general safety knowledge and violence in the workplace. Those who answered yes to having a splatter event or receiving a threat at the hospital were compared to those who did not. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between these outcomes and selected independent variables of interest. p-Values of <0.05 were considered statistically significant.

From January 18 to March 31, 2016, 518 surveys were received and included for analysis for a response rate of 42.9% (518/1207). One survey was excluded from analysis due to <50% completed response items. Self-reported program types were 64.5% (334/518) public university-affiliated, 23.2% (120/518) private university affiliated, 7.1% (37/518) community, and 5.2% (27/518) military. Residents were 83.0% = male and 17.0% = female. Overall, reported eye protection usage was 95% amongst all residents and 22% of residents reported experiencing a violent threat in the workplace. The risk of experiencing a splatter event was not statistically associated with residency type, gender, or geographic region. Senior residents were at an increased likelihood of experiencing a splatter event (OR 1.22, [95% CI 1.06-1.41], p = 0.006) when compared to PGY-1 residents. The risk of a violent experience at work was not statistically associated with residency type, year of residency training, or gender. Residents in the Northeast were more likely to have a violent experience (OR 2.78 [95% CI 1.41-5.49] p = 0.003). Overall, residents felt that they had adequate training to prevent occupational hazards (mean of 3.9/5 on Likert scale) and respond to hazards (mean of 3.7/5 Likert).

Occupational hazards are not uncommon in orthopedic surgery training with high rates of improper eyewear PPE use and poor awareness of Occupational Safety and Health Administration and AAOS guidelines. Violence in the workplace impacts over one in 4 residents and training programs and hospitals should improve education and report efforts. Continual yearly PPE training and awareness of AAOS guidelines could be intertwined with duty hour and/or case logs in order to ensure residents are exposed to this material on a regular basis.

hepatitis C virus (HCV) is an increasingly important public health problem worldwide. Health care workers providing care to women of childbearing age are uniquely placed in their practices to identify a significant proportion of at-risk patients and to provide appropriate screening and counselling. The primary objective of this guideline is to provide accurate, current information to those offering reproductive care to women living with HCV. This document is also intended to raise awareness of HCV in both the medical and general populations.

the areas of clinical practice considered in formulating this guideline are disease prevention, targeted screening of individuals at risk of contracting HCV, management of identified patients in the context of reproductive care, and the appropriate referral of patients to those with particular expertise.

implementation of these guidelines should facilitate identification of infected individuals. It should also result in improved physical and mental well-being for patients and their families and reduction in transmission rates.

the literature between 1966 and 2000, including non- English language publications, was extensively searched utilizing Medline. A multidisciplinary group consisting of experts within the fields of obstetrics and gynaecology, infectious diseases, hepatology, and public health convened in Montreal in February 2000. The working group also included a patient and a representative from the Hepatitis C Society of Canada. The level of evidence for the recommendations has been determined using the criteria described by the Canadian Task Force on Periodic Health Examination.

the public health benefits of increased identification of at-risk individuals, diagnosis, treatment, implementation of risk reduction behaviours, and reduced transmission rates, both on an individual and at the community level, are significant. However, it must be remembered that the diagnosis of a chronic disease may have far reaching effects for the individual patient and her family.

• a)

  Screening

  • •

    Universal screening for HCV is not recommended, although targeted screening should be offered to all women falling into any at-risk category. Testing should take place following adequate counselling and informed consent of the patient (III B).

• b)

  Preconception and early pregnancy care

  • •

    Ideally, preconception or early pregnancy evaluation should include determination of risk of infection with hepatitis C, counselling, and testing as appropriate (III B).

  • •

    Patients aware of their HCV positive diagnosis should be evaluated before embarking on pregnancy for complications that may compromise maternal health during pregnancy (III B).

  • •

    Pregnancy is not generally contraindicated on grounds of HCV infection alone (Although it is contraindicated in the context of ribavirin therapy.) (III B).

• c)

  Care during pregnancy

  • •

    There is a risk of vertical transmission which is greater if the woman is also infected with human immunodeficiency virus (HIV) (II-2 A).

  • •

    Antenatal care will need to be tailored individually to meet the specific needs of the woman's medical and obstetrical condition, including the monitoring of liver function (II-2 A).

  • •

    Alcohol should be avoided (II-2 A).

  • •

    Immunization against hepatitis A and B should be provided as required (II-2 A).

  • •

    Routine Caesarean section is not recommended as a specific intrapartum measure to reduce the risk of vertical transmission of hepatitis C (II-2 D).

  • •

    Breastfeeding is not contraindicated (II-3 B).

• d)

  Care of infant

  • •

    All infants born to HCV positive mothers should be evaluated for evidence of hepatitis C infection (III A).

• e)

  Contraception and hormone replacement therapy

  • •

    Barrier methods should be recommended to those with multiple sexual partners (II-3 B).

  • •

    The extent of liver disease should be carefully evaluated before considering the use of hormonal contraception or hormone replacement therapy (III B).

• f)

  Universal precautions

  • •

    Universal precautions/routine practices and additional precautions are recommended in dealing with all patients for the protection of both health care worker and patient (II-2 A).

references were collected through Medline searches and comparison made to existing current guidelines for assessment of consistency. External reviewers expert in their field were also consulted.

le virus de l'hépatite C (VHC) pose une menace de plus en plus sérieuse à la santé publique à l'échelle mondiale. Les travailleurs de la santé qui s'occupent des femmes en âge de procréer sont particulièrement bien placés pour identifier un nombre important de femmes à risque et fournir les services de dépistage et de counseling appropriés. Le principal objectif de ces lignes directrices est de fournir une information exacte et à jour à tous ceux et celles qui prodiguent des soins de santé en reproduction aux femmes vivant avec le VHC. Ce document vise aussi à sensibiliser le monde médical et le grand public au problème de l'hépatite C.

ces lignes directrices ont été élaborées en tenant compte des domaines suivants de la pratique clinique : la prévention des maladies, le dépistage ciblé des individus à risque d'infection par le VHC, la prise en charge des patientes identifiées dans le contexte des soins de santé en reproduction et la bonne manière de les diriger vers les soins spécialisés appropriés.

la mise en pratique de ces lignes directrices devrait permettre de mieux identifier les femmes infectées et contribuer au mieux-être physique et mental des patientes et de leur famille ainsi qu'à la réduction des taux de transmission.

en utilisant MEDLINE, on a mené une recherche approfondie de la littérature médicale, publiée entre 1966 et 2000, en anglais aussi bien qu'en d'autres langues. En février 2000, à Montréal, eut lieu une rencontre d'un groupe pluridisciplinaire composé d'experts dans les domaines de l'obstétrique et de la gynécologie, des maladies infectieuses, de l'hépatologie et de la santé publique. Ce groupe de travail comprenait aussi une patiente et un représentant de la Société de l'hépatite C du Canada. Le niveau d'évidence accompagnant chaque recommandation est basé sur les critères définis par le Groupe de travail canadien sur l'examen médical périodique.

du point de vue de la santé publique, il y a des avantages importants à tirer d'une meilleure identification des individus à risque, du diagnostic, du traitement, de la mise en œuvre de pratiques réduisant le risque et les taux de transmission, à la fois au niveau de l'individu et de la collectivité. Cependant, il faut se rappeler que le diagnostic d'une maladie chronique peut entraîner des conséquences très sérieuses pour les patientes et leur famille.

• a)

  Dépistage : le dépistage universel du VHC n'est pas recommandé. Cependant, un dépistage sélectif devrait être offert à toutes les femmes qui appartiennent à une catégorie quelconque de risque. Les tests devraient n'être administrés qu'après un counseling approprié et le consentement éclairé de la patiente (III B).

• b)

  Soins précédant la conception et au stade précoce de la grossesse :

  • •

    Idéalement, une évaluation précédant la conception ou au stade précoce de la grossesse devrait comprendre le diagnostic du risque d'infection par l'hépatite C, le counseling et les tests nécessaires (III B).

  • •

    Les patientes qui sont conscientes d'un diagnostic positif de VHC devraient être évaluées avant de devenir enceintes de manière à identifier les complications qui pourraient compromettre la santé maternelle durant la grossesse (III B).

  • •

    À elle seule, l'hépatite C ne constitue pas une contreindication de grossesse (Elle est toutefois contre-indiquée en cas de traitement à la ribavirine.) (III B).

• c)

  Soins durant la grossesse :

  • •

    Le risque de transmission verticale est plus grand si la patiente est aussi infectée du virus de l'immunodéficience humaine (VIH) (II-2).

  • •

    Les soins prénataux doivent satisfaire aux besoins particuliers selon la condition médicale et obstétricale de la patiente, y compris la surveillance de la fonction hépatique (II-2 A).

  • •

    Les boissons alcooliques doivent être évitées (II-2 A).

  • •

    L'immunisation contre l'hépatite A et B selon le besoin (II-2 A).

  • •

    La césarienne systématique n'est pas recommandée comme moyen spécifique de réduire le risque de transmission verticale de l'hépatite C au moment de la naissance (II-2 D).

  • •

    L'allaitement n'est pas contre-indiqué (II-3 B).

• d)

  Soins des nouveau-nés :

  • •

    Tous les enfants nés de mères porteuses du VHC doivent être examinés pour dépister la présence de l'hépatite C (III A).

• e)

  Contraception et hormonothérapie substitutive :

  • •

    Il faut recommander aux femmes qui ont des partenaires sexuels multiples d'utiliser des méthodes contraceptives de type barrière (II-3 B).

  • •

    Avant d'envisager la possibilité d'utiliser un contraceptif hormonal ou de suivre une hormonothérapie substitutive, il faut évaluer soigneusement l'étendue de la maladie du foie (III B).

• f)

  Précautions universelles :

  • •

    De manière à protéger les travailleurs de la santé aussi bien que les patientes, on recommande le recours à certaines précautions universelles/pratiques systématiques et autres précautions pour toutes les patientes (II-2 A).

Les références bibliographiques ont été recueillies à partir de MEDLINE et on a comparé les présentes directives à celles en vigueur afin d'en assurer la cohérence. Des examinateurs externes, experts dans leurs domaines respectifs, ont aussi été consultés.

Eye protection in the OR

Key words: eye protection, blood splatter, bloodborne pathogens, standard precautions.

Types of acceptable eye protection

Key words: eye protection, goggles, face shield, bloodborne pathogens, personal protective equipment, PPE.

Caring for patients with cardiovascular implantable electronic devices

Key words: electrosurgery, implantable cardioverter defibrillator, ICD, implantable electronic device, IED, cardiovascular implantable electronic device, CIED, implantable pacemaker.

Determining acceptable clinical situations for immediate use steam sterilization (IUSS)

Key words: flash sterilization, ophthalmology, immediate use steam sterilization, IUSS, cleaning and decontamination.