Grossing practices & hazards

[ineses]

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What are the normal personal protective equipment that you use during grossing at your area of practice?

What is your view on the hazards of formalin in terms of malignancy-related and exposure during grossing?

Thank you

 

[wild0ne]

I'd be interested in hearing from others as well. Until recently, I've never had any asthma-like symptoms (cough, wheezing, etc.). I'm wondering if formalin exposure has played a role in this.

To answer the question, my institution uses a gown, latex gloves, and a face mask/shield for PPE. We gross in a ventilated (not hooded) grossing station. We dictate using a microphone, but are in the process of converting to Dragon. This makes wearing a face-mask inconvenient.

Another concern that I have is that high-risk specimens (HIV, Hep, TB, etc) are rarely labeled as such. Most of the time I find out when I look up clinical history; however, I figured there should be some process in place to notify pathologists to take extra precaution with these specimens.

 

[KeratinPearls]

What are the normal personal protective equipment that you use during grossing at your area of practice?

What is your view on the hazards of formalin in terms of malignancy-related and exposure during grossing?

Thank you

Surgical cap, mask, gown, gloves with an additional pair of surgical gloves over, shoe overs.

Formalin really burns your eyes and nose if you have a specimen left in formalin overnight onwards. I guess its best to rinse your specimen for a few minutes before handling specimens.

Also, I hear Bouins is toxic too....some of the residents in my program use acetic acid instead of Bouins.

I just try to avoid the burning sensation from the formalin as much as I can. Avoid Bouins as well, but I think it fixes ink to specimens better than acetic acid??

 

[HbyHA]

what people wear varies from resident to resident. most wear a washable gown, face shield, gloves, and a cut resistant glove under their gloves. we all gross at reasonably well-ventilated benches which will be improved when we get a brand spanking new gross room (though probably sometime in 2023 due to the crappy economy...)

formalin exposure levels are measured by those badges that we have the PAs wear from time to time (they spend the most time using formalin since they're in there every day). we've been in the safe range for a long time. i think a couple of female residents were wearing respirators when they were pregnant, just in case.

on another note: we have some people who use scalpels and those ultra sharp flexible blades (known fondly as "death blades") WITHOUT handles. Seriously???? i yell and scream when i see people doing this (i'm a former chief and i just can't help myself, safety first!)

 

[KeratinPearls]

what people wear varies from resident to resident. most wear a washable gown, face shield, gloves, and a cut resistant glove under their gloves. we all gross at reasonably well-ventilated benches which will be improved when we get a brand spanking new gross room (though probably sometime in 2023 due to the crappy economy...)

formalin exposure levels are measured by those badges that we have the PAs wear from time to time (they spend the most time using formalin since they're in there every day). we've been in the safe range for a long time. i think a couple of female residents were wearing respirators when they were pregnant, just in case.

on another note: we have some people who use scalpels and those ultra sharp flexible blades (known fondly as "death blades") WITHOUT handles. Seriously???? i yell and scream when i see people doing this (i'm a former chief and i just can't help myself, safety first!)

How do those cut resistant gloves work? I've heard of them but never used them. Do most programs use these types of gloves? Are they much more expensive than regular gloves per box? I'd be interested in getting the chair to purchase them.

 

[green mantis]

How do those cut resistant gloves work? I've heard of them but never used them. Do most programs use these types of gloves? Are they much more expensive than regular gloves per box? I'd be interested in getting the chair to purchase them.

The gloves are made w/ a metallic mesh, kind of like chain mail. They protect against slices but not against stabs.

The brand, we used at my residency, came individually packaged. We were expected to wear it on our off hand. We wore normal gloves (latex, nitrile, etc) over it. That way, you didn't get it dirty & could re-use it later. I didn't particularly like them because they made palpating more difficult.

BTW, we called those long flexible blades (made by Sakura) long swords & short swords. I need to order some where I work. Slicing a mastectomy well is quite difficult w/out one.


----- Antony

 

[yaah]

People use those blades without handles? Yikes. Those things can almost cut bone.

 

[2121115]

Why would a handle help? The hand you are in danger of cutting is your opposite hand, not the hand that is holding the blade. Actually, holding the blade with out a handle gives you better control and you don't have to take it on and off (sometimes you are more likely to hurt yourself getting the blade off of a holder than you are just holding it). Not to mention it is just faster, especially if you change blades a lot.

 

[KluverB]

... high-risk specimens (HIV, Hep, TB, etc) are rarely labeled as such. Most of the time I find out when I look up clinical history; however, I figured there should be some process in place to notify pathologists to take extra precaution with these specimens.

Universal precautions. Treat every specimen as if it's got HIV, HCV, TB, and CJD, all at the same time, because it just possibly might.

Though having said that, grossing varies from resident/fellow to resident/fellow. Myself: double gloves; disposable apron; from time to time eye-wear, the disposable kind. For autopsy, "full gear". Few folks tend to go overboard around here, even the pregnant ones. Those who are averse to opening colons certainly provide a lot entertainment for the rest of us when they don their ultimate protective super-suits.

 

[ineses]

Thank you for your replies so far. Anyone routinely using respirator?

Some animal studies show that formalin is carcinogenic. What is your comment regarding our grossing practices and this?

To an earlier comment, in my area of practice, those who is confirmed biohazards i.e. HIV/Hep will have an additional yellow with black lines sticker pasted on the request form. I agree though that all cases should be treated as potentially biohazard.

There is a blade remover which makes blade changing safe for the user. It is made of plastic and you would insert the blade into this plastic box, press and the blade will be removed.

 

[yaah]

Why would a handle help? The hand you are in danger of cutting is your opposite hand, not the hand that is holding the blade. Actually, holding the blade with out a handle gives you better control and you don't have to take it on and off (sometimes you are more likely to hurt yourself getting the blade off of a holder than you are just holding it). Not to mention it is just faster, especially if you change blades a lot.

If you have ever used these super sharp blades you would not say that. They are incredibly sharp and flexible, very easy to do serious damage to yourself. When you cut tissue, you also have to apply uneven pressure and a simple slip can mean the blade slips backwards and punctures you.

 

[HbyHA]

If you have ever used these super sharp blades you would not say that. They are incredibly sharp and flexible, very easy to do serious damage to yourself. When you cut tissue, you also have to apply uneven pressure and a simple slip can mean the blade slips backwards and punctures you.

not to mention if someone tries to use them with the sharp side UP because they aren't paying attention!

oh and if you're using forceps instead of your non-dominant hand to hold stuff, you won't cut it! it's different when eviscerating and you may be working in small space where you can't see your hand as well.

 

[KluverB]

...Anyone routinely using respirator?...

I've occasionally grossed in my SCUBA gear. 😉

 

[Gene_]

What are the normal personal protective equipment that you use during grossing at your area of practice?

What is your view on the hazards of formalin in terms of malignancy-related and exposure during grossing?

Thank you

I wear a thin long sleeved gown and a single pair of gloves while grossing. I keep my face out of the specimen to avoid ovary juice and the like. Any case that I know has infectious diseases I allow to fix overnight before cutting.

I am sure the formalin exposure in increasing my risk for cancer, but I don't think the overall risk is worth me getting upset about.

 

[sohsie]

One trick I had for protective equipment is to put on a pair of glover, then put on disposable sleeves (or disposable gown with long sleeves) and poke a hole in each sleeve so that your thumb fits into the hole and the sleeve doesnt ride up the arm. Now, put a second pair of gloves over everything. Change the top layer of gloves avery so often when grossing.

The benefits are:
1) The sleeves dont ride up the arm
2) You can slip off the used top layer of gloves and slip on a new pair without messing up anything.
3) When you are done grossing and are removing everything, the last thing you will be removing is a clean pair of gloves (the first pair).