Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital

Article Abstract:

Hepatitis B virus and the human immunodeficiency virus (HIV), the virus that causes AIDS, may be transmitted by accidental contact with human blood. Surgical procedures are thought to be a particularly dangerous time for accidental exposure to blood, but actual data on the risks are lacking. Despite the lack of data, some have called for preoperative testing of patients for HIV infection so that additional safety precautions might be made in these cases. In an attempt to learn more about the risks of blood contact involved in surgery, 1,307 operations were observed to determine the frequency of intraoperative exposure to blood. Exposures were classed as either parenteral or cutaneous. Parental exposures included needle sticks, puncture with a surgical instrument, or contamination of broken skin or mucous membrane. A cutaneous exposure involves the contact of unbroken skin with blood or other body fluid. A total of 22 parenteral and 95 cutaneous exposures were observed in the 1,307 operations. The wearing of double gloves has become a common practice, and examination of the gloves revealed that the outer glove was three times more likely to be punctured than the inner glove, indicating that double gloving is effective in reducing some exposure to blood. The rate of blood exposure risk did not change for those patients who were either known to be HIV-positive, or who were known to be a member of a high-risk group. This implies that preoperative HIV testing is not likely to have any appreciable effect on safety in the operating room. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, AIDS (Disease), Operating room personnel

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Management of occupational exposures to blood-borne viruses

Article Abstract:

Health care workers may be exposed to hepatitis B (HBV), hepatitis C (HCV), or HIV while on the job, and guidelines exist for post-exposure care. The best strategy for preventing occupational infection, however, may be to avoid exposure in the first place. Blood tests to detect infection may be the most reliable way of assessing the risk of exposure. Estimates of the infection potential of HBV range from 2% to 40%. Persons who have an adequate antibody titer to the HBV e antigen (HBeAg) may be immune to HBV. Post-exposure therapy for nonimmune persons may include administration of HBV hyperimmune globulin and recombinant HBV vaccine. The risk of occupational exposure to HCV is not fully known. Post-exposure therapy with interferon alfa may not be altogether effective, and no other antiviral agents are known to prevent HCV infection after exposure. HCV infection may lead to chronic hepatitis in 50% of infected adults. The risk of becoming infected with HIV through occupational exposure is estimated to be 0.2%. Zidovudine may be the only drug known to have clinical benefit in HIV-infected persons. Follow-up testing is recommended.

HIV infection, Drug therapy, HIV infections, Occupational diseases, Virus diseases, Blood-borne diseases, Bloodborne diseases, Hepatitis

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The infected health care provider

Article Abstract:

The Centers for Disease Control guidelines may not be sufficient to prevent disease transmission from medical staff to patients. Two recent articles document hepatitis B and hepatitis C transmission from infected surgeons to patients despite adherence to infection prevention guidelines. Nonetheless, hepatitis transmission remains an exceedingly rare event, especially compared with other causes of surgical complications, and it does not justify extraordinary measures. Indeed, mandatory testing of clinicians is impractical because of the growing list of blood-borne diseases. It may also backfire in that surgeons may be unwilling to treat infected patients if they know they would be forbidden to perform surgery should they contract an infection. Blunt suture needles, better designed instruments, reinforced gloves, new surgical techniques, and less invasive procedures could contribute to lowering the risk of surgeon-to-patient transmission. In the meantime, immunizing clinicians against hepatitis B would help.

Editorial, Nosocomial infections, Cross infection, Hepatitis B virus

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