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Safety precautions in Mohs micrographic surgery for patients with known blood-borne infections: a survey-based study
Matteo C LoPiccolo1, Mark R Balle, David J Kouba
1Division of Mohs Micrographic Surgery, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA.
Purpose:
A survey-based study was conducted to gather expert experience on safety procedures used when performing Mohs micrographic surgery (MMS) on patients with known infectious hepatitis or human immunodeficiency virus (HIV).
Methods:
Six hundred eighty-four fellowship-trained Mohs surgeons were surveyed to examine the types of safety protocols used when treating patients with known infectious hepatitis or HIV and the frequency of exposure injuries to laboratory and surgical personnel from these patients.
Results:
One hundred eighty-eight (27.5%) surveys were collected; 64.7% of respondents reported at least one exposure injury to surgical or laboratory personnel in the past year, and 4.8% reported exposure from a patient with known hepatitis or HIV infection. Risk of reporting at least one injury from a patient with known infection within the past year was significantly less when also reporting disposal of the ink applicator after each use (relative risk [RR] = 0.109) and greater when employing laboratory personnel with no medical education or background (RR = 3.857). No exposures were reported from respondents using blunt skin hooks, safety scalpels, safety syringes, smoke evacuators, a separate ink supply, or 24-hour formalin fixation.
Conclusion:
Although firm associations cannot be made from this study, the data suggest that certain measures may help to reduce the rate of exposure injuries in MMS.
Insights
Mohs surgery safety protocols may reduce exposure injuries. Disposing of ink applicators and using specific safety tools are associated with fewer incidents in patients with hepatitis or HIV.
Area of Science:
- Dermatology
- Surgical Safety
- Infectious Disease Control
Background:
- Mohs micrographic surgery (MMS) requires stringent safety measures.
- Patients with infectious hepatitis or human immunodeficiency virus (HIV) present unique considerations.
Purpose of the Study:
- To survey Mohs surgeons on safety protocols for patients with hepatitis or HIV.
- To assess the frequency of exposure injuries in MMS personnel.
Main Methods:
- A survey was distributed to 684 fellowship-trained Mohs surgeons.
- The survey examined safety protocols and reported exposure injury rates.
Main Results:
- 27.5% of surveys were returned; 64.7% reported at least one exposure injury.
- 4.8% of injuries were from patients with known hepatitis or HIV.
- Disposing of ink applicators and using safety tools correlated with reduced injuries.
Conclusions:
- Certain safety measures may decrease exposure injury rates in MMS.
- Further research is needed to establish firm associations.
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