Universal Precautions Are Not Universally Practiced by Anesthesiologists

Abstract

To the Editor: The recent article by Tait and Tuttle provided data on the portion of anesthesiologists who have incorporated into their practice recommendations for prevention of transmission of blood-borne pathogens [1]. Although the information is quite revealing, several points require clarification. The date of the survey was not indicated although the timing is relevant for interpreting the results. The Occupational Safety and Health Administration (OSHA) published a standard on Occupational Exposure to Blood-Borne Pathogens in December 1991 requiring full implementation by July 1992. This mandated that employers subject to OSHA regulations implement an exposure control plan requiring use of gloves and other barrier protection when health care personnel perform tasks which may result in exposure to blood or body fluids. Annual educational programs on the use of universal precautions are required for employees. The timing of Tait and Tuttle's survey relative to these federally mandated programs is significant for interpretation of the survey data and assessing the relevance to current practices of anesthesia personnel. The primary strategy for prevention of occupational transmission of hepatitis B virus (HBV) to health care workers is the use of hepatitis B vaccine [2]. In their discussion of the use of universal precautions, the authors have not differentiated the risks of human immunodeficiency virus (HIV) from that for HBV. Additionally, hepatitis C virus (HCV) has been transmitted via needlestick injury to health care workers [3], and, since there is currently no vaccine for this virus, universal precautions remain the primary prevention strategy. The risk of transmission of HCV after a HCV-contaminated needlestick injury appears to be approximately 4% [3] compared with 0.3% risk for HIV transmission after a HIV-contaminated needlestick [4]. In their Discussion, the authors have incorrectly quoted from a previous publication by Berry and Greene [5]. The calculated risk of a needlestick is 0.14% per anesthetic, and this does not represent a specific calculation of HIV risk per anesthetic as indicated by Tait and Tuttle. The 0.14% injury rate per anesthetic was calculated as the overall percutaneous exposure incidence in anesthesia health care workers in the four studies published in the literature as of 1992 (11 percutaneous exposures, needlestick or other sharp item injury, in 8142 anesthetics). One final clarification is the discrepancy between data in the Results and Abstract [1] sections on the percentage of respondents reporting clean or contaminated needlestick injuries in the preceding 12 mo. According to Table 1(p. 625), 72% and 32% of respondents reported needlestick injuries that were clean or contaminated, respectively; however, the abstract reversed the data. The data from this survey indicate that compliance with universal precautions is not universal among anesthesiologists. It is encouraging that the rate of compliance was greater in more recent graduates, who were likely instructed in and have adopted the use of these techniques during residency training. This would suggest that adherence to universal precautions will become more widespread as new graduates enter practice. Arnold J. Berry, MD Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322 Elliott Greene, MD Department of Anesthesiology, Albany Medical Center, Albany, NY 12208