Exposure risks related to the management of three wound drainage systems

In response to the Occupational Safety and Health Administration regulations and Centers for Disease Control and Prevention guidelines, health care employers must explore and incorporate new methods to protect staff and patients from blood-borne pathogens. An area directly affected by the new OSHA standards is the postoperative management of surgical drainage systems. This study compared three surgical wound drainage systems: a "closed" system (Tru-Close) and two currently used drainage systems (Hemovac, and Mini-Snyder) for nursing practices and risk of exposure to blood or body fluids in a simulated setting.

Fifty-eight volunteer registered nurses were asked to choose appropriate personal protection equipment and use recommended universal precautions while measuring and emptying fluid and reactivating each of the drainage systems and to complete a satisfaction questionnaire. Each postoperative wound drainage system was filled with simulated wound drainage and connected to a manikin in an empty patient room. Exposure/contamination was defined as spilling, dripping, or splashing of simulated drainage fluid anywhere in the patient's room or bathroom.

Forty-five percent of nurses who emptied bulb evacuator systems and 40% of nurses who emptied Hemovac systems had resulting contamination to the environment or exposure to self. There were no contaminations with the Tru-Close system. Most contaminations were droplets of fluid on environmental surfaces rather than on the nurses themselves. Most nurses chose gloves for personal protection regardless of the system used. Gowns and face shields were rarely used. Most contaminations were due to emptying simulated fluid (27%) or emptying rinse water (29%) into the patient's toilet. Twenty-three percent (23%) of contaminations occurred while simulated fluid was poured into a container at the bedside. The most common object contaminated was the toilet seat (67%). The bed linen was contaminated 16% of the time. Nurse's gloves were exposed in 6% of the trials.

As administrators and researchers explore new methods to protect patients, health care providers, and the environment from blood-borne pathogens, changes should be balanced with the impact on patient care and user satisfaction.