Severe haemolysis and renalfailure in a patient with paroxysmal nocturnal haemoglobinuria

The post mortem room is a potential source of danger from contamination caused by glove punctures. The objective of this study was to assess the incidence of hand injury and hand contamination during post mortem examinations. A prospective study of injury and glove puncture rate was conducted during post mortem examinations performed in 1990 on adults in Northwick Park Hospital mortuary. Four pathologists and two assistants performed a total of 44 post mortem examinations on adults. All participants completed a questionnaire after each examination, recording the total number of gloves used and the number of hand injuries and glove perforations sustained. Just over 8-3% of gloves were punctured; 31-8% of these punctures went unnoticed. Evisceration was the procedure most likely to result in hand contamination. The study highlights a significant risk which could be reduced by more care, frequent glove changes, and hand washing during post mortem examinations. In particular, gloves should be changed and hand washed when evisceration has been completed. The protection of medical laboratory workers is of great importance and many precautionary measures have found their way into standard medical laboratory practice. One obvious safety measure is the donning of gloves before handling fresh human tissue. The post mortem room is a potential source of danger to both pathologists and their assistants. Because pathologists are not required to protect patients from infection in the same way as surgeons are, they may neglect to protect themselves against contamination during post mortem examinations. Like surgeons, pathologists use sharp instruments in the presence of free body fluids. Thus if they are injured they may run similar risks of contamination. Furthermore, a glove may be punctured in the course of a post mortem examination without actually incurring an injury, but a pre-existing skin lesion may become contaminated. This second risk may be compounded if the puncture goes unnoticed so that the glove is not changed and the hand not washed for some time. In particular, evisceration of the cadaver involves the use of sharp instruments and may expose jagged edges of bone that are potential sources of danger. To quantify these risks, glove punctures and hand injuries were recorded during post mortem examinations of adults. The relative risk of the evisceration procedure was also assessed. Methods Four pathologists and two technicians took part in the study. One ofthe pathologists was of consultant grade with over 20 years of post mortem examination experience. The other three were juniors with between one and five Department of Histopathology, Northwick Park Hospital, Watford Road, Harrow, Middx HAl 3UJ J Weston G Locker Correspondence to: J Weston Accepted for publication 31 July 1991 177 group.bmj.com on June 18, 2017 Published by http://jcp.bmj.com/ Downloaded from