Occupational exposure and protection in perioperative period of patients with human immunodeficiency virus infection/acquired immune deficiency syndrome complicated with spinal surgery

doi:10.3877/cma.j.issn.1674-1358.2018.05.010

Abstract

Abstract:

Objective

To investigate the perioperative treatment of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) complicated with spinal diseases and the occupational exposure and protective measures of medical personnel.

Method

From January 2010 to February 2016, a total of 56 patients with HIV/AIDS underwent spinal surgery in Beijing Ditan Hospital, Capital Medical University were analyzed, retrospectively, including 14 patients undergoing cervical surgery, 24 patients undergoing lumbar surgery, and 10 patients undergoing thoracic surgery. Discectomy was performed in 8 cases. Digital orthopedic navigation was carried out in 36 cases with spinal surgery. The number, mode, location and level of occupational exposure in all patients with HIV/AIDS during spinal surgery were detected, respectively, and the measures taken and the infection after exposure were summarized.

Result

There were 20 cases of primary exposure, 2 cases of secondary exposure and 3 cases of tertiary exposure. The main exposure patterns and sites were needle puncture and mucosal splashing during operation. A total of 15 cases (60%) were mainly exposed to hands and 6 cases (24%) were mucosal spatter. There were 11 cases (44%) with direct exposure to the left hand and 4 cases (16%) with the right hand, but the difference was not statistically significant (χ²= 0.68,P= 0.56), and the number of finger exposures was index finger (20%) > thumb (16%) > palm (12%) > dorsal hand (8%) > middle finger (4%). According to the principle of prevention and treatment after occupational exposure, none of the medical staff got HIV infection.

Conclusions

Occupational exposure risk in spinal surgery in patients with HIV/AIDS should not be ignored. Under the premise of following, the basic principles of orthopedic surgery in perioperative period, digital orthopedic navigation technology is taken to perform minimally invasive incision surgery. Strict implementation of standardized procedures for prevention of occupational exposure can effectively avoid occupational exposure and post-exposure infection.

Key words: Human immunodeficiency virus, Spinal surgery, Digital orthopaedics, Occupational exposure, Protection

Sheng Sun, Qiang Zhang, Changsong Zhao, Xin Li, Rugang Zhao, Yao Zhang. Occupational exposure and protection in perioperative period of patients with human immunodeficiency virus infection/acquired immune deficiency syndrome complicated with spinal surgery[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(05): 472-477.

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References 26

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手术方式	例数	暴露例次数	暴露方式(例次)		构成比(%)
手术方式	例数	暴露例次数	针刺伤	体液飞溅/黏膜溅染	构成比(%)
经皮穿刺球囊扩张椎体成形术	4	5	5	0	20.00
导板微创置钉腰椎后路间盘切除减压植骨融合内固定术	11	2	2	0	8.00
微创经椎间孔镜间盘切除术	10	1	1	0	4.00
腰椎后路切开病灶清除减压内固定术	13	9	6	3	36.00
导航下胸椎后路切开复位减压内固定植骨术	4	3	1	2	12.00
颈椎前路椎体次全切减压植骨融合内固定术	10	3	3	0	12.00
颈椎后路椎管扩大成形术	4	2	1	1	8.00

手术方式	例数	暴露例次数	暴露方式(例次)		构成比(%)
手术方式	例数	暴露例次数	针刺伤	体液飞溅/黏膜溅染	构成比(%)
经皮穿刺球囊扩张椎体成形术	4	5	5	0	20.00
导板微创置钉腰椎后路间盘切除减压植骨融合内固定术	11	2	2	0	8.00
微创经椎间孔镜间盘切除术	10	1	1	0	4.00
腰椎后路切开病灶清除减压内固定术	13	9	6	3	36.00
导航下胸椎后路切开复位减压内固定植骨术	4	3	1	2	12.00
颈椎前路椎体次全切减压植骨融合内固定术	10	3	3	0	12.00
颈椎后路椎管扩大成形术	4	2	1	1	8.00

项目		例次数	构成比(%)
暴露方式		?	?
?	体液飞溅、黏膜溅染	6	24.00
?	皮肤接触	4	16.00
?	针刺伤	15	60.00
?	拇指(左/右)	4(3/1)	16.00(12/4)
?	食指(左/右)	5(4/1)	20.00(16/4)
?	中指(左/右)	1(1/0)	4.00(4/0)
?	无名指(左/右)	0(0/0)	0.00(0/0)
?	小指(左/右)	0(0/0)	0.00(0/0)
暴露级别		?	?
?	一级	20	80.00
?	二级	2	8.00
?	三级	3	12.00
处理措施		?	?
?	局部挤压、流动水冲洗消毒	20	80.00
?	大量生理盐水冲洗眼部黏膜	5	20.00
?	暴露者专家评估及预防用	?	?
?	药方案执行	19	76.00
预防用药方案		?	?
?	基本用药	11	44.00
?	强化用药方案	8	32.00
随访1年结果		25	100.00
预防用药时间		?	?
?	< 2 h预防用药	13	52.00
?	< 24 h预防用药	2	8.00
?	> 48 h用药	4	16.00

项目		例次数	构成比(%)
暴露方式		?	?
?	体液飞溅、黏膜溅染	6	24.00
?	皮肤接触	4	16.00
?	针刺伤	15	60.00
?	拇指(左/右)	4(3/1)	16.00(12/4)
?	食指(左/右)	5(4/1)	20.00(16/4)
?	中指(左/右)	1(1/0)	4.00(4/0)
?	无名指(左/右)	0(0/0)	0.00(0/0)
?	小指(左/右)	0(0/0)	0.00(0/0)
暴露级别		?	?
?	一级	20	80.00
?	二级	2	8.00
?	三级	3	12.00
处理措施		?	?
?	局部挤压、流动水冲洗消毒	20	80.00
?	大量生理盐水冲洗眼部黏膜	5	20.00
?	暴露者专家评估及预防用	?	?
?	药方案执行	19	76.00
预防用药方案		?	?
?	基本用药	11	44.00
?	强化用药方案	8	32.00
随访1年结果		25	100.00
预防用药时间		?	?
?	< 2 h预防用药	13	52.00
?	< 24 h预防用药	2	8.00
?	> 48 h用药	4	16.00

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