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More Should Be Done to Protect Surgical Patients From Intraoperative Hepatitis B Infection

Shirley Paton , RN, MN, Shimian Zou , MD, PhD and Antonio Giulivi , MD, FRCPC
Infection Control and Hospital Epidemiology
Vol. 23, No. 6 (June 2002), pp. 303-305
DOI: 10.1086/502055
Stable URL: http://www.jstor.org/stable/10.1086/502055
Page Count: 3
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More Should Be Done to Protect Surgical Patients From Intraoperative Hepatitis B Infection
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Abstract

EXCERPT When do we, as a society, have the right or the duty to deny a person’s right to work in a chosen profession? The article by Spijkerman et al. in this issue of Infection Control and Hospital Epidemiology once again raises this question. The article reports that a surgeon was unresponsive to repeated attempts at hepatitis B vaccination, and then was infected with hepatitis B at least a decade before discovery through public health department investigations of symptomatic infections among some of his most recent patients. During the course of 4 years, the surgeon, unknowingly infected with hepatitis B virus (HBV), appears to have transmitted HBV to 28 patients. Since 1970, more than 375 patients worldwide have been infected with hepatitis B from their surgeon. In the United States, 19 patients were infected from a cardiothoracic surgeon who tested positive for both hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg). In 1996, in the United Kingdom, 20 patients were infected from a cardiovascular surgeon who tested positive for HBeAg. In 1994, following hip replacement surgery, a Welsh woman was infected and died of acute hepatitis B that was shown to be genetically identical to her surgeon’s hepatitis B; the surgeon tested positive for HBsAg and antibody to hepatitis B e antigen (anti‐HBe) and negative for HBeAg. In Canada, an orthopedic surgeon who tested positive for HBeAg infected 4 patients. Now, in this issue, we read that a surgeon from The Netherlands who tested positive for HBsAg and HBeAg infected 28 patients during 4 years. There was transmission to 28 patients during both high‐risk and exposure‐prone procedures, and also unexpectedly during low‐risk procedures. Spijkerman et al. found that the surgeon’s infection control practices were adequate; transmission occurred even when no break in infection control procedure or surgical technique occurred.

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