Blood contamination is a major problem during surgical procedures. The risk of such problems increases as the arrears to be operated on are highly vascularized. Viral contamination through blood spilling is a major concern in such cases. Fetal infections like the human immunodeficiency virus can transmit through such incidents. Protective mechanisms and careful history of the patient can prevent such incidents.
What Are the Infections?
The infections which can transmit are hepatitis B, hepatitis C infection, and human immunodeficiency virus. That is why proper patient history must be taken before a surgical procedure. Vaccine status should be tested. Different blood tests should be done. These are:
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Antigen-antibody test for HIV.
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Nucleic acid tests (NAT).
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CD 4+ cell count.
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Hepatitis B surface antigen.
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HCV antibody test.
What Are the Protection Methods?
The protection methods include patient preparation and protection against contamination.
1. Patient Preparation:
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Pre-operated shaving of the patient should be avoided.
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Skin staplers should be used whenever possible for suturing.
2. Preparation In the operatory:
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2% glutaraldehyde should be used to half-fill up the suction bottle.
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If heavy blood loss is, expected, instruments should be covered with plastics.
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A mop soaked in a bleaching solution with available chlorine of 10,000 parts per million is used to clean the spilled blood on the floor.
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Sterilization and disinfection of the surgical items before and after should be done. Cleaning with the ultrasonic cleaner, disinfection with 2 % glutaraldehyde (Cidex) for 12 hours, and sterilization with the help of an autoclave should be done.
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The circuit of the anesthesia machine should be decontaminated by autoclaving, low-temperature steam, or by immersion in 2 % glutaraldehyde (Cidex) for 12 hours.
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Any inexperienced or extra person should be absent during the procedure.
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Safe handling of sharp objects. Use an instrument holder to touch the sharp instruments instead of a hand.
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Whenever possible, use disposable instruments.
3. Preparation During Surgical Procedures:
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Diathermy and surgical scissors should be used in place of a scalpel.
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Stiff sutures should be avoided, and excess sutures should be cut off immediately.
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Use minimal incision to prevent less blood loss.
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Laparoscopic surgery is preferred as it reduces the chance of blood loss. It is also indicated in HIV patients. After the laparoscopic procedure, slow withdrawal of the surgical unit is necessary to reduce aerosol contamination. Also, the insufflator should be stopped, and the pneumoperitoneum sucked out before withdrawing the ports gently.
4. Operators Precaution:
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The operator must use goggles to protect the eyes.
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Double musk should be used. N 95 surgical masks can be worn above the normal three-ply surgical masks. These are particularly helpful against aerosol contamination also.
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The face shield can be used as a protective barrier against spilling.
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Double gloves are used to prevent needle prick injury.
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Closed-toe, non-slip boots with leggings or gum boots should be used. The lower level of the gown should extend below the upper level of the gumboots.
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A disposable plastic apron is to be worn beneath the gown.
What Are the Methods of Gowning and Gloving?
The proper method of gowning and gloving must be followed for proper infection control. These methods are:
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The gown's material must be microbial and fluid and should be resistant to tears and punctures.
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The gowns should be lint-free to prevent airborne contamination and should be free of toxic substances such as dyes.
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Repeated laundering and sterilization of woven fabrics should be done as it decreases the barrier's effectiveness.
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At the end of the procedures, gowns are removed before the gloves.
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Folds the contaminated surface of the gown on the inside and rolls it away from the body to prevent any cross-contamination.
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For removing gloves, the wearer uses a glove-to-glove, and then a skin-to-skin technique. This grasps the under the cuff of the glove with the gloved fingers on the other hands and pulls it off inside out. After that, slips the ungloved fingers inside the other glove and slips it off inside out.
What to Do After Exposure?
After the exposure following things can be done to clean the area:
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Wash the area with soap and water. If it is over the skin, a disinfectant can be applied. But it should not be applied in areas like the eyes.
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To clean the eyes, flush with water and saline solution.
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For mucous membrane exposure in the mouth or nose, flushing with water can be done. 0.5 % povidone-iodine gurgel in such cases can be helpful to reduce viral and bacterial load.
What Is the Treatment for Exposure?
For different pathogens, treatment protocols must be different:
1. Hepatitis- B
Ideally, all healthcare personnel should receive the hepatitis B vaccine beforehand. If the person is not vaccinated, post-exposure treatment should start within 24 hours and not later than seven days. If the person is not vaccinated, hepatitis B immune globulin (HBIG) and hepatitis B can be given depending upon the infection status of the source person. Follow-up treatment in such cases is not recommended. Though the person should look out for any potential sign of infection (like yellow skin and loss of appetite). 2 months after the vaccine test can be completed.
2. Hepatitis - C
There is no post-exposure treatment available for hepatitis C exposure. But follow-up procedures should be maintained. Test for hepatitis-c antibody and liver enzyme levels should be done immediately after treatment and repeated after six months.
3. Human Immunodeficiency Virus
No post-exposure vaccine is available for human immunodeficiency virus (HIV) infection. A four-week combination of two or three anti-viral drugs is recommended in such cases. This prophylactic treatment should be started as soon as possible. Test for HIV infection should be done as soon as possible during the exposure, and periodic follow-up should be maintained for at least six months. As anti-retroviral therapy has side effects, people should look out for any potential symptoms of drug side effects.
For pregnant persons, such procedures are not applicable. As anti-retroviral therapy, the vaccine can not be given due to the chance of fetal damage.
Conclusion
Contamination of blood and mucosa with the body and face is a major concern. To prevent such incidents, proper care should be taken during surgical procedures. Proper growing and gloving, and using disposable instruments are very effective in such cases. Above all proper medical history of the patient and testing are necessary to eliminate chances of contamination.
