Occupational exposure during emergency department thoracotomy: A prospective, multi-institution study

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Occupational Health

Background:

• Occupational exposure is a critical concern in emergency department thoracotomy (EDT).
• Previous data on human immunodeficiency virus/hepatitis prevalence and occupational exposure rates exist for other trauma procedures, but not specifically for EDT.
• This study hypothesized a higher occupational exposure risk during EDT compared to other operative trauma procedures.

Purpose of the Study:

• To determine the occupational exposure risk for healthcare providers during emergency department thoracotomy (EDT).
• To identify risk factors associated with occupational exposure during EDT.
• To evaluate the effectiveness of personal protective equipment (PPE) in mitigating exposure risks.

Main Methods:

• A prospective, observational study conducted across 16 US trauma centers from 2015-2016.
• Surveyed 1,360 resuscitation providers participating in 305 EDTs.
• Analyzed risk factors for occupational exposure (percutaneous injury, mucous membrane, open wound, eye splash) using logistic regression.

Main Results:

• An overall occupational exposure rate of 7.2% per EDT was documented.
• Trainees accounted for the majority of exposures (68%), predominantly through percutaneous injuries during the thoracotomy procedure (73%).
• Utilization of each personal protective equipment item correlated with a 34% decreased risk of occupational exposure (OR, 0.66; P = 0.010).

Conclusions:

• The occupational exposure risk during EDT, while present, should not deter providers from performing this critical procedure.
• Practices exist that increase unnecessary risk, highlighting the need for improved universal precaution compliance.
• Enhanced use of personal protective equipment is paramount to further minimize occupational exposure risks during emergency department thoracotomy.