INJURY AND EXPOSURE DATA, RISK OF INFECTION
 
Surgeon to patient transmission of bloodborne pathogens:
 
HIV - Documented transmission of HIV from surgeons to patients has been reported twice; by a dentist in the US to six patients, and an orthopedic surgeon in France to one patient.
HBV - Documented transmission of hepatitis B from thoracic surgeons to multiple patients has been reported in the UK and US.
HCV
In the US, several health care provider to patient transmissions of HCV infection were reported in 2002:
· US: Anesthesiologist to patient: Cody et al. HCV Transmission by Anesthesiologist to a patient. Arch Int Med 2002;162:345-350
· US: Cardiac surgeon to 3 or more patients. Rabin R. Officials: Surgeon likely infected 3 patients. Newsday, 3/27/02, p.A3
· US: Cardiac surgeon to patient. Fiser W. Letter to the editor. Should Surgeons be Tested for Bloodborne Pathogens? Inf Control Hosp Epidem 2002;23:296-297
· In Spain, UK, Germany, anesthetists have transmitted HCV to patients.
Patient to healthcare worker transmission of bloodborne pathogens; occupationally infected healthcare workers:
 
HIV-The CDC monitors the number of occupationally acquired HIV infections in healthcare workers. As of December 1999, the number was 192 (56 documented and 136 suspected). Over 80% were the result of sharps injuries. Assuming that between 1% and 2% of patients are HIV-positive (and therefore that 1% to 2% of needlesticks are HIV-contaminated) between 18 to 35 new occupational HIV infections would occur from percutaneous injuries each year. Infections resulting from blood exposures to non-intact skin or mucous membranes would add between 2 to 4 cases (based on a transmission rate of .09% for a mucous membrane exposure).
Hepatitis B - 250 healthcare workers die annually due to hepatitis B despite the availability of vaccines. The CDC estimates that 400 new occupational HBV infections occurred in 1995 among U.S. health care workers, down from 17,000 in 1983. (Arch Intern Med 1997;157:2601-2603)
Hepatitis C - There is not a vaccine and chronic infection is the rule. Healthcare workers are at an estimated 20-40 fold greater risk occupationally from HCV than HIV. Of the estimated 400,000 health care worker sharps injury exposures in the acute care setting annually in the US, 20,000 to 30,000 are to HCV. Of those exposed health care workers, 500 to 700 will acquire the disease. Hepatitis C is the most common chronic bloodborne infection in the US. Healthcare workers face greater exposure and disease risks as the prevalence of HCV in the patient base increases. HCV is the cause of half of chronic liver disease deaths each year; chronic liver disease being the 10th leading cause of death among adults in the US. (Source: Frontline Healthcare Workers Safety Conference, Aug. 6-8, 2000 Washington, DC.)
Under-reporting of injuries in the OR
Underreporting of sharps injuries, blood contamination of the hands, and splashes to the eyes and face is most evident in surgery. Surveys indicate that as few as 30% to 4% of exposures may be actually reported by surgeons.
Average risk of Infection Following a Single HIV, HBV, or HCV-Contaminated Needlestick or Sharp Instrument Injury (Source: CDC - revised 10/13/99)
HIV 0.3%
HBV 6% - 30%
HCV - 1.8%
 
Number of injuries annually
The CDC estimates 500,000 to 800,000 injuries occur annually.
Annual estimated new occupational HBV infection
The CDC estimates that 400 new occupational HBV infections occurred in 1995 among U.S. health care workers, down from 17,000 in 1983. (Arch Intern Med 1997;157:2601-2603)
Annual estimated new occupational HIV infection
Assuming that between 1% and 2% of patients are HIV-positive (and therefore that 1% to 2% of needlesticks are HIV-contaminated) between 18 to 35 new occupational HIV infections would occur from percutaneous injuries each year. Infections resulting from blood exposures to non-intact skin or mucous membranes would add between 2 to 4 cases (based on a transmission rate of .09% for a mucous membrane exposure).
Annual estimated new occupational HCV infection
Data presented at the 2001 Frontline Healthcare Workers Safety Conference in Washington, DC predict 400 to 700 healthcare workers will occupationally acquire HCV infection annually. There is no vaccine or CDC approved post exposure prophylaxis for HCV. Early treatment may prove effective, but therapeutic agents are costly and toxic. Most of the predicted infections may be preventable through education, safer devices and safer work practices.
The consequences of occupational exposure to bloodborne pathogens, whether infections occur or not, annually cause psychological trauma to thousands of health care workers during months of waiting for notification of serological results. Other personal consequences include postponement of childbearing, altering sexual practices and side effects of prophylactic drugs. In the worst case scenarios, infection, chronic disabilities, loss of employment, denial of worker compensation claims, liver transplant, and premature death may result.