Papers

Contamination with blood during management of epistaxis

BMJ 1995; 311 doi: http://dx.doi.org/10.1136/bmj.311.7012.1064 (Published 21 October 1995) Cite this as: BMJ 1995;311:1064
  1. A Simon Carney, senior house officera,
  2. Jennifer Weir, senior house officera,
  3. David L Baldwin, consultanta
  1. aDepartment of Otolaryngology, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB
  1. Correspondence to: Mr Carney, Department of Otolaryngology, Derbyshire Royal Infirmary, Derby DE1 2QY.
  • Accepted 3 August 1995

The management of medical emergencies is known to expose medical staff to the risks of blood contamination,1 including infection with HIV and hepatitis B virus.2 Epistaxis is one of the commonest otolaryngological emergencies, requiring treatment that may range from simple chemical cautery to major arterial ligation. We assessed the risk of blood contamination to junior medical staff during the treatment of acute epistaxis and determined patient opinion regarding the junior doctors' use of protective clothing.

Patients, methods, and results

Fifty consecutive cases of acute epistaxis treated by two junior medical staff were prospectively studied. Clean protective theatre clothing with gloves, mask, full face visor, hat, and apron was worn during the treatment of all 50 cases. After treatment, all items of clothing were examined thoroughly for visible blood contamination. Patients were invited to fill in a confidential questionnaire asking whether they felt each specific item of protective clothing their doctor had worn was both appropriate and acceptable to them.

One patient stopped bleeding with manual pressure and required no further treatment. Contamination occurred in 69% (34/49) of actively treated cases. In 27 cases clothing in addition to the gloves was contaminated (55% of all cases). Aprons were soiled in 25 cases, gowns in 22, visors in seven, and masks in six. Contamination varied according to the treatment required (table). If patients were treated with chemical or electrical cautery, contamination extended beyond the gloves in 38%, compared with 74% if a nasal pack was required.

Incidence of blood contamination in 50 cases of acute epistaxis according to treatment. Values are numbers (percentages)

View this table:

Forty nine questionnaires were returned (98%). Forty eight patients found it acceptable and appropriate for doctors to wear protective theatre dress and 46 recognised the need for a protective mask/visor; 15 felt it would be inappropriate for staff to treat them while wearing smart work clothes.

Comment

We have shown that a high incidence of blood contamination occurs during the treatment of epistaxis, especially if a pack is required. A considerable proportion of blood splashes occurred in the facial area, implying a very real risk of viral transfer through the conjunctivae or buccal mucosa if no facial protection is worn. Although the management of epistaxis is an emergency classified by the Department of Health as a category A(i) procedure,2 in many departments in the United Kingdom the minimum of protective clothing is worn.3 Perhaps this is because junior staff underestimate the incidence of blood splashes4 and because cases are usually managed in treatment rooms adjacent to the ward or outpatient clinic, along with other ward or clinic work for which medical staff traditionally wear smart attire. In some accident and emergency departments, after the discovery of high contamination rates,1 staff now wear protective clothing when treating all patients and have found such garments to be adequate for skin protection3 and perfectly acceptable to the public, providing they are clean, tidy, and professional.5 We have shown that in today's infection conscious climate, most patients find the routine wearing of protective dress acceptable during the treatment of epistaxis. There is now a strong case for extending the use of protective clothing to include other medical staff engaged in emergency care.5

Footnotes

  • Funding None.

  • Conflict of interest None.

References

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