Zentralblatt für Chirurgie
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Needlestick, stab, scratch, and cut injuries are a common problem and a significant health hazard among healthcare workers. The aim of this review is to give an overview on the risk of infection in general, abdominal and vascular surgery and to suggest occupational safety measures. Furthermore, we want to discuss insurance-related aspects. ⋯ In addition, the risk of infection is affected by the type and severity of injuries, by the quantity (volume) of blood, the time between injury and cleaning, and the administration of post-exposure prophylaxis. Prevention measures are an important focus in occupational medicine. Comprehensive programmes to prevent injuries (usage of safety devices, surgical gloves, and of disposal containers) have to be continuously considered to minimize risk of infection of healthcare workers.
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Tracheobronchial injuries are rare events but often life-threatening. A great expertise in the field of thoracic surgery is necessary to manage these events. ⋯ The flexible or rigid bronchoscopy is the central diagnostic procedure to classify the injury. Whereas iatrogenic tracheal lacerations can be treated by conservative or operative means depending on severity, traumatic injuries of the tracheo-bronchial system need technically challenging operative reconstructions in almost every case.
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Exposure of the respiratory tract during surgical interventions is an important topic of occupational medicine, which has only rarely been investigated. Based on a literature search, relevant information on the possible health risk is summarised. Within the operating room, an exposure of the respiratory tract to gas (volatile anaesthetics) and aerosols (smoking gas by coagulation) can occur. ⋯ However, available data on health risks of the chronic exposure to smoking gases are still deficient although toxic and cancerogenic organic pyrolysis products are generated. The protection effect of modern air conditioning (e.g., laminar air flow) is only insufficiently investigated. Therefore, further studies on these problems are required.
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Today clinical pathways are established as a basis for the operational and organisational structure of surgical, interventional and conservative treatments in many hospitals. ⋯ IT-based clinical pathways are applicable for routine use in general surgery departments. For certain surgical procedures they are an eligible management device. IT-based clinical pathways lead to an improved operational structure of medical treatment and moreover to a complete and continuous documentation through the electronic file. Especially for departments which are using the electronic file, the use of IT-based clinical pathways can be recommended.