Doctors Infect Patients with Hepatitis, Despite Precautions
By Theresa Tamkins
c.1996 Medical Tribune News Service
Although it is relatively rare, doctors who have hepatitis can
pass the viral infection on to patients during surgery, even when
they use gloves or other devices to protect against such
transmission, according to two reports released Thursday.
In one case, a 47-year-old woman contracted acute hepatitis
after undergoing chest surgery, which was performed by a team of
doctors that included a resident who had acute hepatitis B six
When researchers looked at 144 other patients who may have come
in contact with the infected resident, 19 patients - 13 percent -
had signs of recent infection with the hepatitis B virus, according
to one of two reports published Thursday in The New England Journal
In the second study, a heart surgeon in Spain with chronic
hepatitis C passed the infection to five of 222 patients he
operated on between 1992 and 1994.
Hepatitis is an inflammation of the liver that can result in
loss of appetite, vomiting, darkening of the urine and jaundice, or
yellowing of the skin.
Hepatitis B is highly infectious, and results in a lingering
infection in about 5 percent of cases that can lead to
life-threatening liver failure years later. Hepatitis C is much
more difficult to contract, but causes more serious symptoms. About
70 percent of the time, hepatitis C becomes a chronic
The Centers for Disease Control and Prevention has strict
infection-control guidelines for surgical procedures, including
hand-washing, care and disposal of sharp objects and the wearing of
gloves. What is unique about the new reports is that "we are not
exactly sure how transmission occurred," said CDC spokesperson Tom
In the first case, the resident did not cut or puncture his skin
during surgery, and did not have obvious holes in his gloves,
according to the report.
He did, however, practice tying sutures for extended periods of
time, which caused "paper cut"-like abrasions on his hands. The
virus could have escaped through these tiny openings, and somehow
passed through the gloves, Skinner said.
Since the 1970s, when tests for hepatitis B became available, 34
health-care workers with hepatitis have infected about 350
patients. In most cases, the transmission of hepatitis B occurred
when dentists neglected to wear gloves during oral surgery,
according to Skinner.
Thursday's report of hepatitis B transmission is the first in
the United States involving a chest surgeon, although at least four
such incidents have occurred in the United Kingdom, according to
Should all health-care workers involved in surgery or other
invasive procedures be routinely tested for hepatitis - and
prevented from performing these procedures if the test is positive?
Such a practice not only would be cumbersome and expensive, it also
could make doctors reluctant to treat certain patients, according
to Dr. Julie Louise Gerberding of the University of California, San
Francisco, who wrote an editorial accompanying the studies.
For instance, a surgeon who normally would be willing to operate
on a hepatitis-infected patient would hesitate to do so, if he knew
that becoming infected himself could halt his surgery practice,
Although it would not address the problem of health-care workers
already infected with hepatitis, a more practical solution is to
require that health-care workers be vaccinated against hepatitis,
"We are confident that the risk of transmission from health-care
worker to patient is low," said the CDC's Skinner. The two new
reports "serve as a reminder to all health-care workers who are
exposed to blood of the importance of being immunized against
There currently is no vaccination for hepatitis C.
More information on this story is scheduled to appear in the
following issues of Medical Tribune: the March 21 Internist &
Cardiologist, Family Physician and Obstetrician & Gynecologist
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