Friday, February 1, 2013

Blood and Body Fluid Exposure in the OR- Transmission of Hepatitis B from an Orthopedic Surgeon to Two Patients

Blood and body fluid exposures are typically associated with risk of bloodborne pathogen infection from patient to provider. Here is a recent report in Clinical Infectious Diseases on the transmission of Hepatitis B from an orthopedic surgeon to several patients.

During the evaluation of a needle-stick injury, an orthopedic surgeon was found to be unknowingly infected with hepatitis B virus (HBV) (viral load >17.9 million IU/mL). The surgeon had previously completed two 3-dose series of hepatitis B vaccine without achieving a protective level of surface antibody. 

The investigators performed a retrospective cohort study of all patients who underwent surgery by the surgeon.  A total of 232 (70.7%) of potentially exposed patients consented to testing of HBV by DNA sequencing; 2 were found to have acute infection and 6 had possible transmission (evidence of past exposure without risk factors). Genome sequence analysis of HBV DNA from the infected surgeon and patients with acute infection revealed genetically related virus (>99.9% nucleotide identity). 

 Here are several important points:
  • All healthcare workers must be vaccinated for Hepatitis B and adequate response to vaccination must be documented.
  • For those who fail to mount a response to the HBV vaccine, underlying infection with HBV must be excluded
  • For healthcare workers with HBV infection, restrictions on invasive procedures must be in place as guided by an institution's bloodborne pathogens committee

The risk of doctor-patient bloodborne pathogen exposure is real, and it goes both ways.

Safety first, always.

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