Bone cutting requires special attention as far as infection exposure is concerned keeping in mind that bone specimens often are grossed in a fresh state (in large specimens it is the only option). The generated during sawing, bone dust consists of sharp particles. The particles can be loaded with blood or even infection materials in osteomyelitis or gangrene cases.
Figure 1. Bone and soft tissue fragments after sawing
Fragments of bone and soft tissue inevitably disperse around during cutting, especially if power saw were employed (Figure 1). Sharp bone fragments and the saws can be a source of visible and hidden injuries potential for infection exposure.
While grossing bone specimens, some prophylactic measures can be considered.
A/ preference of hand sawing to power sawing.
Hand saws definitely distribute less bone dust loaded with blood droplets. Although the choice of teeth/inch blade of the saw is determined by the bone cutting methodology, the higher is the number the less is an indiscriminate distribution of the bone dust and fragments. Bone dust collection devices are too bulky for surgical pathology.
B/ obligatory double gloves.
Disposable gloves are notorious for small and often invisible holes. They are highly permeable, especially under conditions of formalin and other chemical exposure. While handling bones, manipulation stretches regular disposable gloves. Even if there were no direct encounters with sawing and cutting instruments, double gloves would be rational as the first line of protection. Blood between gloves is the signal to change both and wash the hands.
Iron impregnated gloves like Kevlar are inconvenient for manipulation, but in longitudinal sawing like in Ewing’s sarcoma when a band saw is used, Kevlar gloves are advisable. A fabric glove (silky or liner) underneath the nitrile one would not hurt. Ansell’s Touch N Tuff® can make a satisfactory protection due to durability.
C/ eye protection glasses and a face mask is unconditionally obligatory as part of PPE. Mask will be discussed in a special section below.
D/ special place for bone specimen processing.
It is a common understanding that bone processing requires a special location due to inevitable fragment and dust that soils indiscriminately the floor around the bone grossing table. This area can have a special schedule of cleaning that is not affordable for general laboratory.
E/ development of specialized grossing table for bone processing.
A specialized Bone Grossing Table was presented at 37th Convention of National Society for Histotechnology. It was developed by TBJ Inc (Figure 2). The specialized grossing table for bones has a large working space (72” wide x36” deep) and intensive backdraft ventilation with high vertical direct flow of the aerosol loaded bone dust/particle filter, removable (easy to clean) perforated exhaust panel with dust/particle filter, adjustable damper for increasing/decreasing airflow, and indicator to monitor airflow velocity. The large surface of the working table provides more opportunities for immobilization tools that prevent distribution of potentially infectious materials in the laboratory.
Figure 2. Specialized Bone Grossing Table.
Specialization of grossing tables can be a step ahead to fulfill OSHA recommendation of safer medical devices that minimize, control or prevent exposure incidents. A separate place and specialized bone grossing table can contribute to prevention of excessive infection exposure while processing bones in surgical pathology.