Transmission of Hepatitis B Virus to Multiple Patients from a Surgeon without Evidence of Inadequate Infection Control

Harpaz, Rafael; Seidlein, Lorenz von; Averhoff, Francisco; Tormey, Michael P.; Sinha, S.; Kotsopoulou, K; Lambert, Steve; Robertson, Betty H.; Cherry, Judy; Shapiro, Craig N.

doi:10.1056/nejm199602293340901

Cited by 214 publications

(107 citation statements)

References 28 publications

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“…11,12 Acute hepatitis B infections in health care settings occur through using finger stick devices for glucose monitoring, blood transfusions; subdermal electrodes for electroencephalograms; and unsafe practices while using multiple-dose vials of medications, or from surgeons, even without evidence of inadequate infection control. 13,14 The estimated prevalence of HBsAg positivity in Turkey is 4.57%. The prevalence of HBsAg positivity among patients who apply to hospitals ranges from 1.30 to 10.88%, depending on region.…”

Section: Discussionmentioning

confidence: 99%

Incidence of acute hepatitis B in patients with spinal cord injury

et al. 2011

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Study design: Retrospective case survey. Objective: To examine incidence and clinical characteristics of hepatitis B infection in individuals with spinal cord injury (SCI). Setting: Inpatient clinic within a physical medicine and rehabilitation hospital specialized in rehabilitation. Participants: A total of 161 patients with SCI. Interventions: Patients' records were investigated and the status of hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV), anti-hepatitis B surface antigen positivity, alanine aminotransferase levels, duration of hospitalization and cost were recorded. Main outcome measures: Incidence of acute hepatitis B. Results: Six patients were diagnosed with acute hepatitis B on the first hospitalization for rehabilitation. A total of 11 patients (4.2%) were HBsAg positive with a previously established diagnosis of hepatitis B virus infection, 1 patient (0.4%) was anti-HCV positive. After a follow-up of 6 months, three of the acute hepatitis B patients progressed into chronic hepatitis B stage. In acute hepatitis B patients' initiation of the rehabilitation was delayed, duration of hospitalization was increased. Conclusions: After SCI, patients are at high risk of acute hepatitis B infection. A high rate of chronicity may be associated with impaired immune response, secondary to neurological deficit. Screening and vaccination protocols may prevent the spread of the hepatitis B infection, healthcare losses and financial loss.

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Section: Discussionmentioning

confidence: 99%

Incidence of acute hepatitis B in patients with spinal cord injury

et al. 2011

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“…44 Whilst procedures such as glove use have had a major impact in reducing risk, it was clear that transmissions could still occur even when infection control procedures were followed , as exemplified by transmissions from a thoracic surgeon to 19 patients reported in 1996. 45 This case, and others, of transmissions from HBeAg positive HCWs resulted in guidance which prevented such individuals from undertaking EPPs in the UK. 46 However, it subsequently became evident that HBeAg negative HCWs could also transmit HBV to patients.…”

Section: Hbvmentioning

confidence: 91%

No longer 'written off' – times have changed for the BBV-infected dental professional

et al. 2017

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There is a recognised potential risk of transmission of blood-borne viruses (BBVs) from infected healthcare workers to patients during exposure prone procedures (EPPs). The restrictions placed on performance of EPPs by infected clinicians in the UK have had a particularly significant impact on dentists, because of the exposure-prone nature of most dental procedures and the difficulties in identifying alternative career pathways in the profession that do not involve EPPs. More recently, the significant positive impact of antiviral drugs on viral load together with a re-categorisation of EPPs in dentistry have resulted in evolution of the guidance with a consequent significant improvement to the career prospects of dentists infected with BBVs. This paper provides an update for practitioners on the progress that has been made and outlines the current position with respect to practice restrictions.

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“…Tereskerz, R.D. Pearson, and J. Jagger Morgan, et al 1992;Johnston, MacDonald, Lee, et al 1992;Heptonstall, Collins, Smith, et al 1994;Harpaz, Von Seidlein, Averhoff, et al 1996;Hospital Employee Health 1996;Incident Investigation Teams and Others 1997), HCV (Esteban, Gomez, Martell, et al 1996;Bosch 1998), and HIV (Lot, Seguier, Fegeux, et al 1999) from physicians to patients during invasive procedures have again raised the question of whether it is advisable for physicians infected with these types of dangerous or lethal bloodborne pathogens to perform invasive procedures, and, if so, under what conditions.…”

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confidence: 99%

“…The transmission of HBV from surgeons who are infected with that virus, and in whom hepatitis B e antigen (HBeAG)-----a marker for high infectivity-----is present, has been well documented (Goodwin et al 1976;Rimland et al 1977;Reingold et al 1982;Polakoff 1986;Welch et al 1989;British Medical Journal 1991;Heptonstall 1991;Prentice et al 1992;Johnston et al 1992;Debarge 1993;Heptonstall et al 1994;Harpaz et al 1996;Hospital Employee Health 1996). In the United Kingdom, ten clusters of HBV involving 81 patients of HBeAG-positive surgeons have been reported (Hospital Employee Health 1996).…”

mentioning

confidence: 99%

“…In the United Kingdom, ten clusters of HBV involving 81 patients of HBeAG-positive surgeons have been reported (Hospital Employee Health 1996). In 1996, one report quanti ed the HBV infection rate among patients of an HBeAg-positive cardiac surgeon, which occurred despite his adherence to accepted infection-control precautions during surgery (Harpaz et al 1996). In addition, it has been documented that HBV-positive surgeons with no detectable HBeAg have transmitted HBV to patients during invasive procedures (Incident Investigation Teams and Others 1997).…”

mentioning

confidence: 99%

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Infected Physicians and Invasive Procedures: National Policy and Legal Reality

Tereskerz¹,

Pearson

Jagger

1999

Milbank Quarterly

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Recent reports of the transmission of hepatitis B, hepatitis C, and HIV from physicians to patients during invasive procedures have again raised the question of whether physicians infected with bloodborne pathogens should perform invasive procedures that place patients at risk, and if so, under what conditions. Attempts to formulate a national policy on this subject must consider the competing interests of the patient's welfare versus the physician's livelihood. A review of the legal aspects of this topic is provided to assist policy makers and to serve as a foundation for the recommended establishment of a multidisciplinary committee to develop a uniform national policy. Both legal and medical realities call for the formulation of a clear policy to guide those who must make the decisions on this issue.

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Transmission of Hepatitis B Virus to Multiple Patients from a Surgeon without Evidence of Inadequate Infection Control

Abstract: In this outbreak there was surgeon-to-patient HBV transmission despite apparent compliance with recommended infection-control practices. We could not identify any specific events that led to transmission.

Cited by 214 publications

References 28 publications

Incidence of acute hepatitis B in patients with spinal cord injury

Incidence of acute hepatitis B in patients with spinal cord injury

No longer 'written off' – times have changed for the BBV-infected dental professional

Infected Physicians and Invasive Procedures: National Policy and Legal Reality

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