Intraoperative transmission of blood‐borne disease in Haemophilia

Abstract

Because HIV and hepatitis B and C infection can be transmitted by exposure to infected blood or blood components, orthopaedists are at risk for HIV and hepatitis infection during surgical procedures. Thus, care must be taken to protect themselves from transmission of HIV and the hepatitis virus. The following precautions are recommended: double latex gloves, changed hourly, or a combination of cloth and latex gloves, enclosed hood and face-masks and operative isolator with umbilical-cord aspirator; knee-length impermeable gowns of high-count polyester weave or plastic-lined nonwoven spun-lace polyester; a combination of shoe-covers that provide waterproof coverage as high as the knee; and disposable drapes. If a member of the operating team is inadvertently pricked or cut, the wound should be washed immediately with iodine, soap and water. If the injured person has been immunized for the hepatitis B (and has adequate titres), or is positive for hepatitis B surface antigen or antibody, no further treatment is necessary. Otherwise, two doses of hepatitis B immune globulin should be given, 5 mL immediately and 5 mL after 1 month. Because HIV infection can be transmitted by exposure to infected blood, orthopaedic surgeons are also at risk for HIV infection. Prospective studies suggest that this risk is very low; nevertheless, healthcare workers need to adhere rigorously to the aforementioned infection-control precautions to minimize the risk of exposure to blood.

Total joint replacement in HIV positive patients

“…37 There have been many recommendations on how to minimize the intraoperative risk. 38 In conclusion, intravenous drug abuse and HIV increase the risk of early infections after total joint replacement. Total joint replacement seems to be a safe procedure in patients with HIV only.…”

Viral hepatitis and the surgeon

“…Other minor factors included: glove failure, skin lesions, long duration of the operation and the use of blood products. While in the majority of cases there were no identifiable causes for the surgical outbreaks, the most likely explanations were thought to be related to needle sticks incurred while suturing and inadvertent cuts through gloves while securing knots 43. For these reasons the following are thought to decrease the risk of intraoperative transmission: use of double latex gloves, changed hourly, enclosed hood and face‐masks and operative isolator with umbilical‐cord aspirator, knee‐length impermeable gowns, a combination of shoe‐covers with coverage to the knee and disposable drapes.…”

Therapeutic options in the management of articular contractures in haemophiliacs

“…HIV‐infected haemophiliacs are at risk for bacterial and opportunistic infections with worsening immunosuppresion. Thus, the risk of postoperative infection following orthopaedic surgery is of considerable concern [9].…”