Expert Opinion: Risk of Infection during Surgical Training on Cadavers in Tampere Surgical Education Centre

Tampere Surgical Education Centre (TSEC) offers surgical training on fresh cadavers. TSEC staff aims to look into the medical history of each deceased as well as possible. If according to the medical history or during the autopsy tuberculosis is suspected, the deceased will not be used in surgical training. 

The sexually transmitted or bloodborne viruses (HIV, Hepatitis B or C) are not tested for. The deceased with a history of narcotic or alcohol abuse will not be used in training. It is however impossible to fully exclude a possibility of viral infections during the lifetime by medical history only. 

The risk of tuberculosis infection during surgical training is low, because the deceased with a suspicion of tuberculosis are not used in training and the infection foci are not opened during the surgery. I therefore find the use of FFP-3 mask by the trainees needless. 

The testing for the bloodborne pathogens from the deceased is in practice impossible. In health care, numerous operations are performed to unidentified viral carriers without knowing their carrier state. In order to avoid bloodborne transmission of infections, certain instructions have been set for the care of patients. These instructions must also be followed during the surgical training on cadavers: 

1. Take conventional precautions to prevent bloodborne transmission: 
   1. Use safety instruments when possible 
   2. Handle sharp objects always with eye contact 
   3. Do not pass sharp objects from hand to hand, use intermediate trays instead 
   4. After use, put stinging or cutting waste straight to the sharps container 
   5. Do not recap a used needle 
   6. Always wear protective gloves when handling blood, bloody instruments or other body fluids 
   7. Use masks and protective eye covers, if there is a risk of spatters to the mucosa 
   8. Remove visible blood stains immediately with suitable disinfectant 
2. In all operations (also during surgical training on cadavers): 
   1. Always wear indicator gloves or double gloving, when there is a risk of perforation or breakage 
   2. Use mask and eye covers to prevent blood spatters to the mucosa 
3. Make sure that you have been properly vaccinated against Hepatitis B and the active immunity has developed 
   1. If unsure, contact your occupational health services 
4. Make the acquaintance of the directive for blood exposure incidents 

By complying with the safety measures above, the use of cadavers in surgical training is safe relative to the prevention of infections.

Tampere, July 2nd 2015 
Jaana Syrjänen 
Docent, Chief Physician 
Hospital Hygiene, Tampere University Hospital