Do modern spectacles endanger surgeons? The Waikato Eye Protection Study.

Department of Plastic and Reconstructive Surgery, Waikato Hospital, Hamilton, New Zealand.
Annals of Surgery (Impact Factor: 8.33). 04/2007; 245(3):495-501. DOI: 10.1097/01.sla.0000252406.94464.16
Source: PubMed


Despite documented cases of infectious disease transmission to medical staff via conjunctival contamination and widespread recommendation of protective eyewear use during surgical procedures, a large number of surgeons rely on their prescription spectacles as sole eye protection. Modern fashion spectacles, being of increasingly slim design, may no longer be adequate in this role.
A survey was conducted among the surgeons at Waikato Hospital from December 7, 2004 to February 1, 2005, to assess current operating theater eyewear practices and attitudes. Those who wore prescription spectacles were asked to assume a standardized "operating position" from which anatomic measurements were obtained. These data were mathematically analyzed to determine the degree of palebral fissure protection conferred by their spectacles.
Of 71 surgical practitioners surveyed, 45.1% required prescription lenses for operating, the mean spectacle age being 2.45 years; 84.5% had experienced prior periorbital blood splashes; 2.8% had previously contracted an illness attributed to such an event; 78.8% participants routinely used eye protection, but of the 27 requiring spectacles, 68.0% used these as their sole eye protection. Chief complaints about safety glasses and facial shields were of fogging, poor comfort, inability to wear spectacles underneath, and unavailability. Our model predicted that 100%, 92.6%, 77.8%, and 0% of our population were protected by their spectacles laterally, medially, inferiorly, and superiorly, respectively.
Prescription spectacles of contemporary styling do not provide adequate protection against conjunctival blood splash injuries. Our model predicts the design adequacy of currently available purpose-designed protective eyewear, which should be used routinely.

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    ABSTRACT: Mucocutaneous and transconjunctival exposure are important portals for the transmission of blood-borne infections to surgeons and health-care workers. Despite this knowledge, few surgeons or their assistants wear protective equipment for procedures perceived to be affiliated with less risk. This study investigates the potential risk of mucocutaneous and transconjunctival blood splash injury during common laparoscopic and endourologic procedures undertaken using standard video endoscopy equipment. Masks combined with eye shields were consecutively collected from the surgeon, surgical assistant, and theater nurse after a variety of endourologic procedures over a 4-month period. These were analyzed macroscopically for visible blood droplets. Modern forensic techniques were then instituted to assess for nonvisible blood exposure. Eye shields from 118 procedures performed by five surgeons were collected. Two hundred and thirty-six masks were examined for visible and visually enhanced evidence of blood contamination. In total, 48.5% of surgeons' masks, 29.5% of assisting surgeons' masks, and 31.8% of scrub nurse masks were positive for either visible or visually enhanced blood contamination. In terms of evidence of blood splash, 84.2% of laparoscopic nephrectomies, 66.7% of pyeloplasties, and 58.3% of flexible ureteroscopies tested positive. Splash injuries remain commonplace, even with the use of video endoscopy equipment. Therefore, all health-care workers should be encouraged to wear eye and face protection when undertaking both endoscopic and laparoscopic urologic procedures. These observations may have broader implications relevant to all minimally invasive surgical procedures, because they demonstrate a much greater potential risk of blood-borne disease transmission during surgery than has been previously appreciated.
    Full-text · Article · Jul 2008 · Journal of endourology / Endourological Society
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