Grossing injuries

[path doc]

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Cut injuries while grossing are fairly common. However, I have not seen any specific guidance for post-exposure care in this situation.

Please share your experiences. More particularly, I would like to know:

• Do you wear cut-resistant gloves.
• Do you also use a new blade for each grossing session/ each large specimen or don't bother at all.
• Do you go by the belief that as the specimens are formalin-fixed the risk of contracting HIV/Hep is minuscule or has anyone taken PEP following such an injury.

 

[Pathman1000]

Cut injuries while grossing are fairly common. However, I have not seen any specific guidance for post-exposure care in this situation.

Please share your experiences. More particularly, I would like to know:

• Do you wear cut-resistant gloves.
• Do you also use a new blade for each grossing session/ each large specimen or don't bother at all.
• Do you go by the belief that as the specimens are formalin-fixed the risk of contracting HIV/Hep is minuscule or has anyone taken PEP following such an injury.

You need to go to occupational health. This forum is not for personal health advice.

 

[path doc]

You need to go to occupational health. This forum is not for personal health advice.

Yes, I have seen occupational health.

Just wanted a overview of what other pathologists do to prevent and treat such injuries as it is fairly common but not the same as a needle stick injury (i.e. usually fixed tissue/ formalin involved)

 

[icpshootyz]

Cut injuries while grossing are fairly common. However, I have not seen any specific guidance for post-exposure care in this situation.

Please share your experiences. More particularly, I would like to know:

• Do you wear cut-resistant gloves.
• Do you also use a new blade for each grossing session/ each large specimen or don't bother at all.
• Do you go by the belief that as the specimens are formalin-fixed the risk of contracting HIV/Hep is minuscule or has anyone taken PEP following such an injury.

I don't gross any more in my practice, but as a resident I never wore cut resistant gloves, I used a blade as long as it had an edge (same blade, multiple cases), and never had a cut/stick that required PEP. I do believe that formalin makes any sort of exposure far less likely to result in any sort of infection, but I'm not sure if that means I wouldn't take PEP if I had been stuck during grossing of a truly infectious case.

 

[Euchromatin]

I also don't gross currently, but as a resident I only wore a Kevlar cut-resistant glove on my non-dominant hand (underneath double layer of surgical gloves with long cuffs) while doing autopsies. I typically just wore a single layer of regular gloves while grossing. Our department had ample scalpel and disposable knife blades available and we were encouraged to use a new blade with every case to prevent contamination/crossover between specimens (i.e. getting friable tumor from one case on another specimen), so, yes, I generally had a new blade for each large resection specimen.

I only cut myself once (during the one autopsy I forgot to wear my cut-resistant glove, by the way). I reported it to occupational health immediately and they were able to test some of the patient's blood (leftover from other testing while she had been admitted that had not been discarded yet) for the relevant blood-borne pathogens and luckily the testing was all negative.

I can't advise you regarding your own situation.

 

[Ishie]

1. I managed to stab myself through cut resistant gloves, so I feel like I'm more careful without them. Fortunately, it was a one use blade and the patient was negative for anything frightening. I'll use them on my holding hand if I have a large specimen with different consistencies (like a teratoma) where the blade is more likely to slip. I probably should use them for frozens since that's the nasty blades, but it makes it harder for me to get a nice section.
2. Yes, I use a new blade regularly, if for no other reason, it's incredibly frustrating to attempt to cut anything with a dull knife, and regardless of injuries, I don't want to drag floaters through my other specimens. It's embarrassing to find a chunk of placenta on a breast slide. Only exception is expensive blades (wipe with bleach between specimens) and frozen blades (change every 4-5 frozens).
3. People have too much faith in formalin's penetration of large specimens (whether for disease risk or for having the interior of it rot over a long weekend). If it's small biopsies, the risk of disease transmission after a short time is negligible. In a large specimen, the center of the specimen is going to be just as disease-laden as it was before unless it's been sectioned before sitting or has been in for a long time. I've been places where a large specimen that was meant to go for flow was rescued from formalin and still had viable cells so interpret that as you will.

 

[yaah]

Always pay attention to tense lesions that may be cystic. Sometimes lesions are surprisingly cystic (like liver tumors) or surprisingly tense (ovarian tumors). Don't cut into it so whatever is in there comes out aimed at your eye.