Low Risk of Surgeon-to-Patient HIV Transmission

The risk of an HIV-positive surgeon transmitting the virus to a patient is very low, according to a new study.

Researchers at the Israeli National Center for Infection (Israeli Ministry of Health; Jerusalem, Israel) examined the cases of an Israeli heart surgeon who had practiced for about 20 years and performed about 150 operations each year. In January 2007, the surgeon tested positive for HIV, after which the health ministry instructed hospitals to offer HIV tests to all patients on whom the surgeon had operated since 1997. Computerized lists of the surgeon's patients generated by the hospitals based on operation reports were crosschecked with the national registry of HIV-positive patients; none of the patients was registered. The patients were then contacted by regular mail or telephone, advised that an unnamed surgeon who operated on them was found to be HIV positive, and told that although the risk for HIV transmission via surgery was minimal, they were being offered free testing and counseling. A telephone hotline for patients with questions was established at the surgeon's hospital of current employment, and this number was provided via the national news media and in the letters mailed by this hospital. Of the 1,669 former patients identified, 545 agreed to take an HIV test. According to the report, all 545 former patients tested negative for HIV.

After receipt of these results, the Ministry of Health appointed a panel of experts to determine whether and under what conditions the surgeon could resume work. After considering the clinical details of the surgeon's case, the published literature on HIV transmission from infected health-care workers to patients, and the findings of the look-back investigation, the panel recommended allowing the resumption of work, with no restrictions on the types of procedures the surgeon could perform, provided the surgeon met the following conditions: 1) instruction by infection-control personnel at the surgeon's hospital regarding safe practices, including adherence to standard precautions and hand hygiene requirements, double-gloving during all surgery, and immediate reporting of any cuts in gloves or fingersticks, plus agreement by the surgeon to abide by these practices; 2) routine health-care follow-up at 3-month intervals, including measurement of CD4 T-cell count and HIV RNA; and 3) adherence to a prescribed antiretroviral regimen, maintenance of good health, and continued CD4 T-cell level higher than 200 cells/µL, with HIV RNA below the threshold of detection. The study was published in the January 8, 2009, issue of the Morbidity and Mortality Weekly Report (MMWR), a publication of the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA).

Based on the published literature, the panel did not require notification of prospective patients of the surgeon's HIV status because of the extremely low likelihood of transmission

Related Links:
Israeli National Center for Infection
US Centers for Disease Control and Prevention