Prevention of Occupational Transmission of Human Immunodeficiency Virus and Hepatitis B Virus among Anesthesiologists

Abstract

Comment: This provocative article documents an alarming level of noncompliance, perhaps even nonchalance, with established protocols and precautions to prevent transmission of HIV and HBV. The concept of universal precautions assumes that all patients are infected and that barrier techniques should be used to avoid contact with the patient's blood and body fluids. though the risk for occupational transmission of HIV is considered low (0.1% overall, and 0.35%-0.5% for those sustaining needlestick injuries), the fact that contraction of the disease is thought to be uniformly fatal should be of grave concern to the healthcare professional. As of September 1992, the CDC documented occupational seroconversion in 32 healthcare workers (HCW). Moreover, an additional 69 individuals had suspected occupational acquisition. Of those HCW with confirmed occupational transmission of HTV, 84% had received percutaneous exposure, 13% a mucocutaneous exposure, and 3% both types. Although occupational transmission of HIV has not been confirmed among anesthesiologists, HBV infection has for decades been linked with the practice of anesthesiology. Indeed, in terms of prevalence and risk, HBV is the most significant virus to which the anesthesiologist is occupationally exposed. Estimates of HBV seroconversion among anesthesiologists range between 12.7% and 48.6%. Among HCWs in general, approximately 8,700 HBV infections are estimated annually in the United States, and approximately 200 the from acute or chronic HBV infection. In an accompanying and insightful editorial, Dr. John H. Tinker speculated that there are three possibilities to explain such noncompliance. Perhaps anesthesiologists lack concern about their personal risk of infection, or possibly, they are appropriately concerned but have not yet translated this awareness into behavioral and practice changes, because of inertia. However, Dr. Tinker's intriguing third hypothesis is that, despite anesthesiologists' concern and desire to modify their practices, the protocols and alternatives