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| By
Prof. Ravi Kant,
Maulana Azad Medical College, New Delhi In recent years, the centers for Disease Controls and Prevention, Atlanta has issued several sets of recommendations intended to reduce the risks of transmision of blood-born pathogens between patients and Health Care Workers (HCWs). Cognizant of these recommendations, and based on current data, the American College of Surgeons make the following recommendations regarding hepatitis. RELEVANT TO ALL BLOODBORNE PATHOGENS : Surgeons should continue to utilize the highest standards of infection control, involving the most effective known sterile barriers, universal precautions, and scientifically accepted measures to prevent blood exposure. This practice should extend to all sites where surgical care is rendered, and should include safe handling practices for needles and sharp instru-ments. During every operation maximum efforts should be exerted to pre-vent exposure of the patient to the blood of members of the surgical team as well as protection of the surgical team from exposure to the blood of patients. RELEVANT TO ALL POTENTIALLY INFECTED PATIENTS : Surgeons have the same ethical obligations to render care to hepatitis-infected patients as they have to care for other patients. RELEVANT TO HEPATITIS B (HBV): Surgeons with natural or acquired antibodies to HBV are protected from acquiring HBV from patients and cannot transmit the disease to patients. All surgeons and other members of the health care team should know their HBV immune status and become immunized. Immunizations should occur as early as possible in the medical career so that eventually all surgeons will be immunized. RELEVANT TO HEPATITIS B (HBV): Surgeons without evidence of immunity to HBV who perform procedures should know their hepatitis B surface antigen status and if this is positive they should know if they are B antigen positive. In both the instance, expert medical advice should be obtained and all appropriate measures taken to prevent disease transmission to patients. Medical advice should be rendered by an expert panel composed and convened to fully protect practitioner confidentiality. The antigen positive surgeon and the panel should discuss and agree on a strategy for protecting patients who are at risk for disease transmission. RELEVANT TO HEPATITIS C(HCV): Surgeons infected with HCV have no reason to alter their practice based on current information but should seek expert medical advice and appropriate treatment to prevent chronic liver disease. SUMMARY In summary, immunization against HBV appears to be the most effective method of preventing transmission of HBV from patients to members of the surgical team, and surgeons therefore should be immunized against HBV. Such immunization is also most effective way to reduce the risk of transmission of HBV from surgeons to patients. Eventually, by virtue of voluntary or required immunization, essentially all surgeons will be immunized. Prevention of HCV is currently possible only through prevention of blood exposure. REFERENCES I.Sallie R, King R, Silva E, Tibbs C, Johnson P, Will-iams R: Community preva-lence of hepatitis C viraems: A polymerase chain reaction study. J Med Virol, 43: 111-114, 1994. 2. Keien GD, Green GB, Purcell RH, et al: Hepatitis B and hepatitis C in emer-gency department patients. N Engl J Med, 326:1399-1404, 1992. 3. Statement on Surgeon and Hepatitis, Bulltetin of American College of Sur-geons, Vol.84 No.4, page 21-24, April 1999. |
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