ACCIDENTAL INJURIES AND CUTANEOUS CONTAMINATIONS DURING GENERAL SURGICAL OPERATIONS IN A NIGERIAN TEACHING HOSPITAL

ABSTRACTBackground: During surgical operations cutaneous, percutancous and mucous membraneexposures to patients blood or body fluid occurs commonly. These events may predisposethe operating personnel to the acquisition of HIV and hepatitis virus infections. Theseroprevalence of HIV in the developing countries like ours is increasing; the risk ofseroconversion after needle stick injuries involving infected blood has also been documented.There is a need to know the incidence of needle stick injuries and body contaminationduring surgical operation in our hospital, for appropriate preventive measures can bedeveloped. This study was aimed at determine the prevalence of accidental injuries andbody contaminations among the operating pesonnel during general surgical operation,those involved, the circumstances surrounding the injuries or body contaminations andthe factors affecting the prevalence. It is hoped, that this will assist in designing andestablishing appropriate precautionary measures in our environment.Study design: Patients operated for general surgical conditions in a unit of a TeachingHospital Complex ddring a period of 2 years (1997-98) were eligible for participationin the study. A proforma was designed to enter personal biodata, preoperative and intrapostoperativeclinical information of all the patients. All types of general surgical operationswere included, emergency or elective, major or minor, carried out during the day or atnight. A resident doctor not participating in operation was instructed to watch out foraccidental injuries, glove failure and other body contamination, operating personnel werealso instructed to report injuries, glove failure and body contamination.Results: Operating personnel sustained 62 sharp injuries (10.5), these were caused bysuture needle in 57 cases (92.0%), towel clips in 3(4.8%), Knife cut in 2(3.2%). Operatingphysicians sustained 56 cases of sharp injuries (90.3%) and Scrub Nurses in 6(9.7%).Self-inflicted sharp injury in 49(79%) and in 12 cases (21%) injuries were inflicted bythe by the surgeons on their assistants. Left hand was injured in 39 cases (63%) andright in 23 ) (37%). Cutaneous or mucosa membrane contamination with blood or bodyfluid occurred in 232 cases (39.4%). These were made up of wet gown contaminationin 124 (53.5%), glove failure in 72(31%) and splashing of blood or fluids into the faceor eyes in 36 crises (15.5%). Contamination occurred in more than one operatingpersonnel in more than half of the cases. Operating surgeons were affected in 211 cases(91%). The risks of accidental injuries and blood and body fluid contamination weresignificant, if the duration of the operation is more than 1 hour, among the operatingsurgeons and if the operation was a major operation (p<0.05).Conclusion: This study has demonstrated that cutaneous, percutancous, and mucousmembrane exposure to patients’ blood and body fluids are common events duringgeneral surgical operations. Most accidental injuries were due to solid suture needlesticks,mostly injured personnel were the primary operating surgeons, injuries occurredpredominantly on the left hand. This way poses a significant risk of infection with bloodborne pathogens when operating on infected patients

Determinants of management outcome in open tibia fractures in ile-ife

Background:Fracture of a normal tibia shaft constitutes a major trauma mostly sustained by young adults during high-energy injuries. Its superficial location and the subcutaneous characteristics of its anteromedial aspect easily causes open fracture. The objectives of this study were to determine the pattern of presentation, and determinants of management outcome in open fractures of the tibia. Methods: This is a prospective hospital based study. A total of 89 patients aged 4 to 80 years with open fractures of the tibia with or without fibula involvement were studied. All the patients received anti tetanus prophylaxis and intravenous antibiotics as well as wound irrigation, debridement and skeletal stabilisation. Results: Students and traders accounted for the majority of the cases (57.3%). Most of the open tibia fractures 69 (77.5%) had above knee Plaster of Paris cast. The majority of the cases were Gustilo and Anderson type II 32 (36.0%) cases and type I 22(24.7%) cases. There was Correlation between the presence of wound infection and (i) Gustilo and Anderson grading (F -.352, P .001); (ii) Injury to Debridement time in hours (F -.304, P .004); (iii) Osteomyelitis (F .397, P .001); (iv) Delayed union (F .253, P .017); and (v) Union time in weeks (F -.350, P .001). There was also correlation between the following: (i) Injury to Debridement time in hours and the distance from the accident scene to the hospital (F .464, P .001); (ii) The fracture pattern and the union time in weeks (F .353, P .001); and (iii) The presence of osteomyelities and delayed union (F .382, P .001). The commonest complications observed were wound infection 35(39.3%) patients and delayed union 30(33.7%) patients. Conclusion: This study shows that the higher the Gustilo and Anderson grading of the open fractures of the tibia, the more severe the wound and bone infection that occurred. The interval between injury time and wound débridement time affected the treatment outcome

Outcome of the Treatment of Gunshot Open Fractures of the Lower Extremities with 'SIGN' Interlocking Nails

Background: Gunshot injuries are gradually on the increase in civilian populations in developing countries due to increasing violence in our society. The treatment of fractures from these injuries is changing with the use of locked intramedullary nailing becoming an acceptable and effective method of fixation. Surgical Implant Generation Network interlocking nails are gaining universal acceptability in these countries due to ease of use without the need for image intensifier. The purpose of this study was to evaluate the outcome of the use 'SIGN' interlocking nailing in gunshot open fractures of the lower limbs. Methods: This is a prospective study of all patients in three tertiary centres in developing countries who had gunshot fractures of lower limbs fixed with SIGN nails from 1st January to 31st December 2009 and followed up for a period of 2 years. Results: Twenty eight patients with 31 fractures with average age of 32.5years±12.6SD. All the patients were males except one female. Fractures occurred in femur in 20(71.4%) and tibia in 11(29.6%) SIGN nail was used to fix all fractures and union was achieved in all the patients. The most common complication was wound in infection in 5 (15.2%). Conclusion: SIGN intramedullary locked nail provided an effective method of fixation for gunshot fractures of the lower extremity with minimal complication