Occupational risk to surgeons of unrecognized HIV infection in a low‐prevalence area

Abstract

Data are available on the occupational risk to surgeons of the human immunodeficiency virus (HIV) for areas of high HIV prevalence but not for low-risk areas and particularly for unrecognized HIV infection. The 40-year cumulative occupational risk to surgeons caring for patients with unknown HIV serologies in a low-prevalence area was estimated. From May 1989 to May 1991, 4119 consecutive patients with unknown HIV status, hospitalized in our department, were proposed for testing; 100% complied. Acquired immunodeficiency syndrome (AIDS) patients and known seropositive patients operated on during this period were excluded from the study. The prevalence of unknown HIV infection was 0.07%. Taking into account the rate of parenteral injuries, the rate of contamination after an infected parenteral injury, and the total number of operations performed during a 40-year career, we estimated the cumulative risk of unknown HIV infection in our area to be 1%. This risk must be added to those of caring for known infected patients. In high-risk areas (cumulative risk 10%), a high standard of infection control is required for every surgical procedure, even if it is expensive or of doubtful efficacy. It is unrealistic to apply this standard in a low-risk area. HIV testing with informed consent of the patient is an imperfect guard against infection but has the advantage of alerting the surgeon to the risk of contamination on a case-by-case basis; it also offers the seropositive patient the best possibility for a longer life expectancy.

Rare post-tonsillectomy complication in human immunodeficiency virus positive patient: ulcero-necrotic lesion of tonsillar fossa

“…This case also highlights the importance of universal precautions when performing any surgical procedure. Evrard et al have found the prevalence of unknown HIV infection to be 0.07 per cent in a population similar to ours 8 . Taking into account the rate of parenteral injuries, the rate of contamination after an infected parenteral injury, and the total number of operations performed during a 40-year career, these authors estimated the cumulative risk of unknown HIV infection to be 1 per cent, increasing to 10 per cent in high-risk areas.…”

Transport of colloidal particles in lymphatics and vasculature after subcutaneous injection

“…human immunodeficiency virus; dog ACCIDENTAL EXPOSURE to human immunodeficiency virus (HIV) particles via needle sticks or cuts in the health care setting has generated considerable interest in the mechanism of viral transport and incorporation after a subcutaneous exposure (6,11,14,19,26). There is evidence indicating transmission of cancer cells into the lymph and vascular system, although these cells are bigger than viral particles (7,8).…”

Blood splash and tonsillectomy: an underestimated hazard to the otolaryngologist

“…Investigators have estimated the lifetime risk of HIV infection in surgeons to range between 0.5 per cent and 10 per cent depending on seroprevalence where they practice. 7,8 Seroconversion has serious implications not only for the surgeon's career but also for the surgeon's family. Currently, in the Republic of Ireland there is no of cial framework or support set-up for doctors who become seropositive.…”