Dermatologists' Use of Eye Protection

Selezionata da Pietro Cazzola, MD

Protezione oculare dermatologoDon’t play the odds: Wear eye and face protection during dermatologic procedures

Blood and other body fluid pathogen exposure (BBPE) is an important occupational safety issue for dermatologists. In addition to sharps injuries, mucous membrane exposure is important and often overlooked, accounting for more than 35% of documented exposures in two recent studies.1,2

We concur that the likelihood of wearing eye protection is based on perceived risk of splash injury by procedure (cyst excision, Mohs surgery); by location (scalp, face); and, for nurses, by the experience of the person performing the procedure (higher risk for junior residents). The problem of not wearing eye protection is also prevalent in other specialties.3 Although the risk of disease transmission is relatively low via all routes,1,2 there were 58 cases of confirmed (and 150 cases of possible) HIV transmission as of December 31, 2013,4 including at least 2 cases of HIV and hepatitis C transmission via conjunctival exposure.5,6

Our department has made eye protection a priority and the wearing of well-fitting glasses has had a positive impact. We also concur with Pate and Kampp that face protection with a mask or shield is important. Although fogging may be an issue, as identified in their survey responses, more expensive integrated face shield and mask combinations are available.

Attention to BBPE, including wearing eye and face protection and reporting any exposures, could be included in the sign in and sign out procedures, respectively, of your dermatology universal protocol.

References

  1. Nwaiwu CA, Egro FM, Smith S, et al. Seroconversion rate among health care workers exposed to HIV-contaminated body fluids: The University of Pittsburgh 13-year experience. Am J Infect Control. 2017;45(8):896-900. http://www.ajicjournal.org/article/S0196-6553(17)30234-1/fulltext
  2. Egro FM, Nwaiwu CA, Smith S,. Seroconversion rates among health care workers exposed to hepatitis C virus-contaminated body fluids: The University of Pittsburgh 13-year experience. Am J Infect Control. 2017;45(9):1001-1005. http://www.ajicjournal.org/article/S0196-6553(17)30209-2/fulltext
  3. Davies CG, Khan MN, Ghauri AS, Ranaboldo CJ. Blood and body fluid splashes during surgery--the need for eye protection and masks. Ann R Coll Surg Engl. 2007;89(8):770-772. https://publishing.rcseng.ac.uk/doi/10.1308/003588407X209301
  4. Centers for Disease Control and Prevention. Occupational HIV transmission and prevention among health care workers. Available at https://www.cdc.gov/hiv/workplace/healthcareworkers.html. Accessed March 19, 2018.
  5. Hosoglu S, Celen MK, Akalin S, et al. Transmission of hepatitis C by blood splash into conjunctiva in a nurse. Am J Infect Control. 2003;31(8):502-504. http://www.ajicjournal.org/article/S0196-6553(03)00697-7/fulltext
  6. Ippolito G, Puro V, Petrosillo N, et al. Simultaneous infection with HIV and hepatitis C virus following occupational conjunctival blood exposure. JAMA. 1998;280(1):28. https://jamanetwork.com/journals/jama/article-abstract/1152210

Written by  James S Taylor MD 
Written by Thomas J Knackstedt MD 
Written by Alok Vij MD

Dermatol Surg 2018 Jan 01;44(1)31-35, DA Pate, JT Kampp