Occupational exposure during emergency department thoracotomy

A prospective, multi-institution study

Andrew Nunn, Priya Prakash, Kenji Inaba, Alvarez Escalante, Zoë Maher, Seiji Yamaguchi, Dennis Y. Kim, James MacIel, William C. Chiu, Byron Drumheller, Joshua P. Hazelton, Kaushik Mukherjee, Xian Luo-Owen, Rachel M. Nygaard, Ashley P. Marek, Bryan C. Morse, Caitlin A. Fitzgerald, Patrick L. Bosarge, Randeep S. Jawa, Susan Rowell & 5 others Louis J. Magnotti, Adrian W. Ong, Tejal S. Brahmbhatt, Michael D. Grossman, Mark J. Seamon

    Research output: Contribution to journalArticle

    Abstract

    BACKGROUND Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While human immunodeficiency virus/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1.9-18.0%) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures. METHODS A prospective, observational study at 16 US trauma centers was performed (2015-2016). All bedside EDT resuscitation providers were surveyed with a standardized data collection tool and risk factors analyzed with respect to the primary end point, EDT occupational exposure (percutaneous injury, mucous membrane, open wound, or eye splash). Provider and patient variables and outcomes were evaluated with single and multivariable logistic regression analyses. RESULTS One thousand three hundred sixty participants (23% attending, 59% trainee, 11% nurse, 7% other) were surveyed after 305 EDTs (gunshot wound, 68%; prehospital cardiopulmonary resuscitation, 57%; emergency department signs of life, 37%), of which 15 patients survived (13 neurologically intact) their hospitalization. Overall, 22 occupational exposures were documented, resulting in an exposure rate of 7.2% (95% confidence interval [CI], 4.7-10.5%) per EDT and 1.6% (95% CI, 1.0-2.4%) per participant. No differences in trauma center level, number of participants, or hours worked were identified. Providers with exposures were primarily trainees (68%) with percutaneous injuries (86%) during the thoracotomy (73%). Full precautions were utilized in only 46% of exposed providers, while multiple variable logistic regression determined that each personal protective equipment item utilized during EDT correlated with a 34% decreased risk of occupational exposure (odds ratio, 0.66; 95% CI, 0.48-0.91; p = 0.010). CONCLUSIONS Our results suggest that the risk of occupational exposure should not deter providers from performing EDT. Despite the small risk of viral transmission, our data revealed practices that may place health care providers at unnecessary risk of occupational exposure. Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with personal protective equipment is paramount and would further minimize occupational exposure risks during EDT. LEVEL OF EVIDENCE Therapeutic/care management study, level III.

    Original languageEnglish (US)
    Pages (from-to)78-84
    Number of pages7
    JournalJournal of Trauma and Acute Care Surgery
    Volume85
    Issue number1
    DOIs
    StatePublished - Jul 1 2018

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    Thoracotomy
    Occupational Exposure
    Hospital Emergency Service
    Wounds and Injuries
    Trauma Centers
    Operative Surgical Procedures
    Confidence Intervals
    Logistic Models
    Universal Precautions
    Gunshot Wounds
    Cardiopulmonary Resuscitation
    Resuscitation
    Health Personnel
    Hepatitis
    Observational Studies
    Mucous Membrane
    Hospitalization
    Odds Ratio
    Nurses
    Regression Analysis

    Keywords

    • Emergency department thoracotomy
    • occupational exposure
    • personal protective equipment
    • resuscitative thoracotomy
    • universal precautions

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

    Cite this

    Occupational exposure during emergency department thoracotomy : A prospective, multi-institution study. / Nunn, Andrew; Prakash, Priya; Inaba, Kenji; Escalante, Alvarez; Maher, Zoë; Yamaguchi, Seiji; Kim, Dennis Y.; MacIel, James; Chiu, William C.; Drumheller, Byron; Hazelton, Joshua P.; Mukherjee, Kaushik; Luo-Owen, Xian; Nygaard, Rachel M.; Marek, Ashley P.; Morse, Bryan C.; Fitzgerald, Caitlin A.; Bosarge, Patrick L.; Jawa, Randeep S.; Rowell, Susan; Magnotti, Louis J.; Ong, Adrian W.; Brahmbhatt, Tejal S.; Grossman, Michael D.; Seamon, Mark J.

    In: Journal of Trauma and Acute Care Surgery, Vol. 85, No. 1, 01.07.2018, p. 78-84.

    Research output: Contribution to journalArticle

    Nunn, A, Prakash, P, Inaba, K, Escalante, A, Maher, Z, Yamaguchi, S, Kim, DY, MacIel, J, Chiu, WC, Drumheller, B, Hazelton, JP, Mukherjee, K, Luo-Owen, X, Nygaard, RM, Marek, AP, Morse, BC, Fitzgerald, CA, Bosarge, PL, Jawa, RS, Rowell, S, Magnotti, LJ, Ong, AW, Brahmbhatt, TS, Grossman, MD & Seamon, MJ 2018, 'Occupational exposure during emergency department thoracotomy: A prospective, multi-institution study', Journal of Trauma and Acute Care Surgery, vol. 85, no. 1, pp. 78-84. https://doi.org/10.1097/TA.0000000000001940
    Nunn, Andrew ; Prakash, Priya ; Inaba, Kenji ; Escalante, Alvarez ; Maher, Zoë ; Yamaguchi, Seiji ; Kim, Dennis Y. ; MacIel, James ; Chiu, William C. ; Drumheller, Byron ; Hazelton, Joshua P. ; Mukherjee, Kaushik ; Luo-Owen, Xian ; Nygaard, Rachel M. ; Marek, Ashley P. ; Morse, Bryan C. ; Fitzgerald, Caitlin A. ; Bosarge, Patrick L. ; Jawa, Randeep S. ; Rowell, Susan ; Magnotti, Louis J. ; Ong, Adrian W. ; Brahmbhatt, Tejal S. ; Grossman, Michael D. ; Seamon, Mark J. / Occupational exposure during emergency department thoracotomy : A prospective, multi-institution study. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 85, No. 1. pp. 78-84.
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    abstract = "BACKGROUND Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While human immunodeficiency virus/hepatitis prevalence in trauma patients (0-16.8{\%}) and occupational exposure rates during operative trauma procedures (1.9-18.0{\%}) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures. METHODS A prospective, observational study at 16 US trauma centers was performed (2015-2016). All bedside EDT resuscitation providers were surveyed with a standardized data collection tool and risk factors analyzed with respect to the primary end point, EDT occupational exposure (percutaneous injury, mucous membrane, open wound, or eye splash). Provider and patient variables and outcomes were evaluated with single and multivariable logistic regression analyses. RESULTS One thousand three hundred sixty participants (23{\%} attending, 59{\%} trainee, 11{\%} nurse, 7{\%} other) were surveyed after 305 EDTs (gunshot wound, 68{\%}; prehospital cardiopulmonary resuscitation, 57{\%}; emergency department signs of life, 37{\%}), of which 15 patients survived (13 neurologically intact) their hospitalization. Overall, 22 occupational exposures were documented, resulting in an exposure rate of 7.2{\%} (95{\%} confidence interval [CI], 4.7-10.5{\%}) per EDT and 1.6{\%} (95{\%} CI, 1.0-2.4{\%}) per participant. No differences in trauma center level, number of participants, or hours worked were identified. Providers with exposures were primarily trainees (68{\%}) with percutaneous injuries (86{\%}) during the thoracotomy (73{\%}). Full precautions were utilized in only 46{\%} of exposed providers, while multiple variable logistic regression determined that each personal protective equipment item utilized during EDT correlated with a 34{\%} decreased risk of occupational exposure (odds ratio, 0.66; 95{\%} CI, 0.48-0.91; p = 0.010). CONCLUSIONS Our results suggest that the risk of occupational exposure should not deter providers from performing EDT. Despite the small risk of viral transmission, our data revealed practices that may place health care providers at unnecessary risk of occupational exposure. Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with personal protective equipment is paramount and would further minimize occupational exposure risks during EDT. LEVEL OF EVIDENCE Therapeutic/care management study, level III.",
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    TY - JOUR

    T1 - Occupational exposure during emergency department thoracotomy

    T2 - A prospective, multi-institution study

    AU - Nunn, Andrew

    AU - Prakash, Priya

    AU - Inaba, Kenji

    AU - Escalante, Alvarez

    AU - Maher, Zoë

    AU - Yamaguchi, Seiji

    AU - Kim, Dennis Y.

    AU - MacIel, James

    AU - Chiu, William C.

    AU - Drumheller, Byron

    AU - Hazelton, Joshua P.

    AU - Mukherjee, Kaushik

    AU - Luo-Owen, Xian

    AU - Nygaard, Rachel M.

    AU - Marek, Ashley P.

    AU - Morse, Bryan C.

    AU - Fitzgerald, Caitlin A.

    AU - Bosarge, Patrick L.

    AU - Jawa, Randeep S.

    AU - Rowell, Susan

    AU - Magnotti, Louis J.

    AU - Ong, Adrian W.

    AU - Brahmbhatt, Tejal S.

    AU - Grossman, Michael D.

    AU - Seamon, Mark J.

    PY - 2018/7/1

    Y1 - 2018/7/1

    N2 - BACKGROUND Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While human immunodeficiency virus/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1.9-18.0%) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures. METHODS A prospective, observational study at 16 US trauma centers was performed (2015-2016). All bedside EDT resuscitation providers were surveyed with a standardized data collection tool and risk factors analyzed with respect to the primary end point, EDT occupational exposure (percutaneous injury, mucous membrane, open wound, or eye splash). Provider and patient variables and outcomes were evaluated with single and multivariable logistic regression analyses. RESULTS One thousand three hundred sixty participants (23% attending, 59% trainee, 11% nurse, 7% other) were surveyed after 305 EDTs (gunshot wound, 68%; prehospital cardiopulmonary resuscitation, 57%; emergency department signs of life, 37%), of which 15 patients survived (13 neurologically intact) their hospitalization. Overall, 22 occupational exposures were documented, resulting in an exposure rate of 7.2% (95% confidence interval [CI], 4.7-10.5%) per EDT and 1.6% (95% CI, 1.0-2.4%) per participant. No differences in trauma center level, number of participants, or hours worked were identified. Providers with exposures were primarily trainees (68%) with percutaneous injuries (86%) during the thoracotomy (73%). Full precautions were utilized in only 46% of exposed providers, while multiple variable logistic regression determined that each personal protective equipment item utilized during EDT correlated with a 34% decreased risk of occupational exposure (odds ratio, 0.66; 95% CI, 0.48-0.91; p = 0.010). CONCLUSIONS Our results suggest that the risk of occupational exposure should not deter providers from performing EDT. Despite the small risk of viral transmission, our data revealed practices that may place health care providers at unnecessary risk of occupational exposure. Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with personal protective equipment is paramount and would further minimize occupational exposure risks during EDT. LEVEL OF EVIDENCE Therapeutic/care management study, level III.

    AB - BACKGROUND Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While human immunodeficiency virus/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1.9-18.0%) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures. METHODS A prospective, observational study at 16 US trauma centers was performed (2015-2016). All bedside EDT resuscitation providers were surveyed with a standardized data collection tool and risk factors analyzed with respect to the primary end point, EDT occupational exposure (percutaneous injury, mucous membrane, open wound, or eye splash). Provider and patient variables and outcomes were evaluated with single and multivariable logistic regression analyses. RESULTS One thousand three hundred sixty participants (23% attending, 59% trainee, 11% nurse, 7% other) were surveyed after 305 EDTs (gunshot wound, 68%; prehospital cardiopulmonary resuscitation, 57%; emergency department signs of life, 37%), of which 15 patients survived (13 neurologically intact) their hospitalization. Overall, 22 occupational exposures were documented, resulting in an exposure rate of 7.2% (95% confidence interval [CI], 4.7-10.5%) per EDT and 1.6% (95% CI, 1.0-2.4%) per participant. No differences in trauma center level, number of participants, or hours worked were identified. Providers with exposures were primarily trainees (68%) with percutaneous injuries (86%) during the thoracotomy (73%). Full precautions were utilized in only 46% of exposed providers, while multiple variable logistic regression determined that each personal protective equipment item utilized during EDT correlated with a 34% decreased risk of occupational exposure (odds ratio, 0.66; 95% CI, 0.48-0.91; p = 0.010). CONCLUSIONS Our results suggest that the risk of occupational exposure should not deter providers from performing EDT. Despite the small risk of viral transmission, our data revealed practices that may place health care providers at unnecessary risk of occupational exposure. Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with personal protective equipment is paramount and would further minimize occupational exposure risks during EDT. LEVEL OF EVIDENCE Therapeutic/care management study, level III.

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    KW - occupational exposure

    KW - personal protective equipment

    KW - resuscitative thoracotomy

    KW - universal precautions

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