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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 months earlier.

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 of Medicine.

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 infection.

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 Skinner.

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 the report.

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, Gerberding said.

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, she said.

"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 hepatitis B."

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 editions.

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