Fri., 10/17/08 Basic Science, Paper #22, 10:16 am OTA-2008
Conjunctival Contamination Is Significantly Reduced with Appropriate Eye Protection
Alfred A. Mansour, III, MD (n); Jesse L. Even, MD (n); Sharon Phillips, MSPH (n); Jennifer L. Halpern, MD (n);
Vanderbilt University Medical Center, Nashville, Tennessee, USA
Background: Conjunctival contamination from splashed solid or liquid debris during orthopaedic procedures places surgeons at risk for communicable diseases such as human immunodeficiency virus (HIV) and hepatitis B/C. Various studies have demonstrated the importance of protective eyewear, and in fact most institutions mandate protective eyewear. Yet compliance with recommended precautionary measures remains low, and 30% of surgeons do not wear any protective eyewear. Many surgeons use prescription glasses alone as “protective eyewear.”
Purpose: The purpose of this study is to compare the effectiveness of various types of protective eyewear in preventing conjunctival contamination.
Methods: Average intraoperative surgeon head position was determined by analysis of operating room photographs, and a simulation model was constructed. In this model, a mannequin head was placed at an appropriate distance from the surgical field and a femoral osteotomy was performed on cadaveric bone. Colored saline was used to irrigate the osteotomy site. Six experimental groups were tested for their ability to prevent splash contamination of the conjunctiva: (1) low-profile prescription glasses, (2) standard loupes, (3) contoured hard plastic glasses, (4) disposable plastic glasses, (5) combination facemask/ eye shield, and 6) no protection (control). 30 laterally based femoral osteotomies were performed and contamination on both the protective devices and simulated conjunctival surfaces was recorded.
Results: No protective device that was tested was 100% effective. The low-profile prescription glasses and the control both had conjunctival contamination rates of 83.3%. The other eye protective devices showed significantly lower rates of overall contamination: loupes, 50% (P = 0.04); facemask/eye shield, 30% (P = 0.0001); hard plastic glasses, 16.7% (P = 0.0001); and disposable plastic glasses, 3.3% (P <0.0001).
Conclusions: Low-profile prescription glasses provided no added benefit compared to the control in our experimental model and therefore should not be used as sole eye protection during surgical procedures. Eye protective devices that provide protection above and below the eye as well as contoured side protection—similar to the disposable plastic glasses—minimize risk of contamination. For complete protection, devices that contact the face circumferentially or equivalently should be used.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.