๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Sharps Injuries
Sharps Injuries
The CDC estimates that more than 380,000 sharps exposures occur annually.181 Sharps injuries pose an occupational hazard to dermatologists because of the large number of procedures they perform. A 2013 cross-sectional survey of practicing dermatologists and trainees revealed that 85.1% of 336 responders had experienced a needle stick injury during their career. Importantly, 64% of respondents experienced a sharps injury that they did not report.182 The most frequently cited reason for not reporting an injury was the belief that the patient was a low risk for a hematologically spread infectious disease. A similar 2016 survey of dermatology residents showed that, of 351 responders, 76% had a sharps injury during training and 34% went unreported.183 Given the risk of communicable diseases such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), it is important to promptly report injuries to occupational health services so that appropriate baseline and follow-up testing can be informed, and prophylactic medication administered. Improving the ease of access to reporting systems, ensuring anonymity, and encouraging ongoing sharps safety training may increase the prevalence of reporting.182 In addition, continued efforts to decrease the stigma associated with medical errors are essential.
To prevent sharps injuries in dermatologic surgeons and other team members, several preoperative, intraoperative, and postoperative techniques can be employed.184 Preoperatively, one should wear protective devices (gloves, masks, protective eyewear, and protective footwear). Intraoperatively, it is important to practice safe handling and transferring of sharp instruments, minimize the use of sharps, and protect from backsplash injuries. When treating patients with known infectious hepatitis or HIV, the use of blunt skin hooks, safety scalpels, safety syringes, smoke evacuators, a separate ink supply during MMS, or 24-hour formalin fixation resulted in no exposures in 188
surveyed Mohs surgeons.185 Postoperative measures that should be taken include the proper disposal of used sharps.
CONCLUSIONS
Dermatologists perform almost 10 million procedures annually; even in this context, the rate of surgical complications is very low, and the rate of serious surgical complications remains vanishingly rare. Adhering to standard safety recommendations may increase the level of safety for dermatologic surgeons and their patients, and developing protocols for management of surgical complications may help mitigate the severity of these problems when they arise. Critically, patients must be educated preoperatively regarding the risks associated with a given procedure, as managing patient expectations regarding the baseline risk of undesirable outcomes may help foster a team approach to care and management.