ACCIDENTAL INJURIES AND CUTANEOUS CONTAMINATIONS DURING GENERAL SURGICAL OPERATIONS IN A NIGERIAN TEACHING HOSPITAL

Abstract

ABSTRACT
Background: During surgical operations cutaneous, percutancous and mucous membrane
exposures to patients blood or body fluid occurs commonly. These events may predispose
the operating personnel to the acquisition of HIV and hepatitis virus infections. The
seroprevalence of HIV in the developing countries like ours is increasing; the risk of
seroconversion after needle stick injuries involving infected blood has also been documented.
There is a need to know the incidence of needle stick injuries and body contamination
during surgical operation in our hospital, for appropriate preventive measures can be
developed. This study was aimed at determine the prevalence of accidental injuries and
body contaminations among the operating pesonnel during general surgical operation,
those involved, the circumstances surrounding the injuries or body contaminations and
the factors affecting the prevalence. It is hoped, that this will assist in designing and
establishing appropriate precautionary measures in our environment.
Study design: Patients operated for general surgical conditions in a unit of a Teaching
Hospital Complex ddring a period of 2 years (1997-98) were eligible for participation
in the study. A proforma was designed to enter personal biodata, preoperative and intrapostoperative
clinical information of all the patients. All types of general surgical operations
were included, emergency or elective, major or minor, carried out during the day or at
night. A resident doctor not participating in operation was instructed to watch out for
accidental injuries, glove failure and other body contamination, operating personnel were
also instructed to report injuries, glove failure and body contamination.
Results: Operating personnel sustained 62 sharp injuries (10.5), these were caused by
suture needle in 57 cases (92.0%), towel clips in 3(4.8%), Knife cut in 2(3.2%). Operating
physicians sustained 56 cases of sharp injuries (90.3%) and Scrub Nurses in 6(9.7%).
Self-inflicted sharp injury in 49(79%) and in 12 cases (21%) injuries were inflicted by
the by the surgeons on their assistants. Left hand was injured in 39 cases (63%) and
right in 23 ) (37%). Cutaneous or mucosa membrane contamination with blood or body
fluid occurred in 232 cases (39.4%). These were made up of wet gown contamination
in 124 (53.5%), glove failure in 72(31%) and splashing of blood or fluids into the face
or eyes in 36 crises (15.5%). Contamination occurred in more than one operating
personnel in more than half of the cases. Operating surgeons were affected in 211 cases
(91%). The risks of accidental injuries and blood and body fluid contamination were
significant, if the duration of the operation is more than 1 hour, among the operating
surgeons and if the operation was a major operation (p<0.05).
Conclusion: This study has demonstrated that cutaneous, percutancous, and mucous
membrane exposure to patients’ blood and body fluids are common events during
general surgical operations. Most accidental injuries were due to solid suture needlesticks,
mostly injured personnel were the primary operating surgeons, injuries occurred
predominantly on the left hand. This way poses a significant risk of infection with blood
borne pathogens when operating on infected patients.