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Disturbing truth: Providers infect hundreds of patients
HBV the most transmissible, HCV toll next
Since 1970, more than 375 patients worldwide have been infected with hepatitis B virus by their surgeons, according to a recent review article.1 The authors cited the following cases as examples of provider-to-patient transmission of bloodborne pathogens:
HBV: An investigation published last year describes a surgeon in the Netherlands who was unresponsive to repeated attempts at hepatitis B vaccination.2 During the course of four years, the surgeon, unknowingly infected with hepatitis B virus, appears to have transmitted HBV to 28 patients. There was transmission to 28 patients during both high-risk and exposure-prone procedures, and also unexpectedly during low-risk procedures. The surgeon’s infection control practices were adequate, but transmission occurred even when no break in infection control procedure or surgical technique occurred.
In the United States, 19 patients were infected from a cardiothoracic surgeon who tested positive for both hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg).3
In 1996, in the United Kingdom, 20 patients were infected from a cardiovascular surgeon who tested positive for HBeAg.4 In 1994, following hip replacement surgery, a Welsh woman was infected and died of acute hepatitis B that was shown to be genetically identical to her surgeon’s hepatitis B; the surgeon tested positive for HBsAg and antibody to hepatitis B e antigen (anti-HBe) and negative for HBeAg.5 In Canada, an orthopedic surgeon who tested positive for HBeAg infected four patients.6
Hepatitis C virus: Recently, researchers reviewed seven cases of surgeons or anesthesiology staff infected with HCV transmitting HCV to their patients during the course of medical care.7 In most cases, patients were infected through inadvertent exposure to the workers; only two incidents were caused by clear breaches of infection control practices. They also detailed a seven-year retrospective study that identified one case among 2,286 gynecology patients The transmission rates in these various look-back investigations varied from 0.04% to 2.7%, suggesting that, although infrequent for some surgeons with hepatitis C, transmission to patients has clearly been documented.
HIV: Six patients were potentially infected by a dentist in Florida during 1984 to 1989.8 Infection control practices were questionable. One patient was infected from an orthopedic surgeon in France before 1992.9 Unlike the experience with hepatitis B and C, numerous studies and surveillance projects have looked for a link between HIV-infected providers and infected patients and have failed to find one.
1. Paton S, Zou S, Giulivi A. More should be done to protect surgical patients from intraoperative hepatitis B infection. Infect Cont Hosp Epidemiol 2002; 22:303-305.
2. Spijkerman IJB, van Doorn LJ, Janssen MHW, et al. Transmission of hepatitis B virus from a surgeon to his patients during high-risk and low-risk surgical procedures during 4 years. Infect Control Hosp Epidemiol 2002; 23:306-312.
3. Harpaz R, Von Seidlein L, Averhoff FM, et al. Trans-mission of hepatitis B virus to multiple patients from a surgeon without evidence of inadequate infection control. N Engl J Med 1996; 334:549-554.
4. Heptonstall J. Lessons from two linked clusters of acute hepatitis B in cardiothoracic surgery patients. CDR Review 1996; 6:R119-R125.
5. Sundkvist T, Hamilton GR, Rimmer D, et al. Fatal outcome of transmission of hepatitis B from an e antigen-negative surgeon. Commun Dis Public Health 1998; 1:48-50.
6. Johnston BL, Langille DB, LeBlanc JC, et al. Transmission of hepatitis B related to orthopedic surgery. Infect Control Hosp Epidemiol 1994; 15:352.
7. Ross RS, Viazov S, Thormählen M, et al. Risk of hepatitis C virus transmission from an infected gynecologist to patients: Results of a 7-year retrospective study. Arch Intern Med 2002; 162:805-810.
8. Center for Disease Control. Update: Transmission of HIV infection during invasive dental procedures — Florida. MMWR 1991; 40:377-381.
9. Dorozynski A. French patient contracts AIDS from surgeon. Br Med J 1997; 314:250.