HCV or HIV in General Surgeons?

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chemamr

PGY2
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Hi, i have been thinking in this topic for a while, aren´t you afraid of getting infected of HCV/HBV/HIV or only god knows what else more during your residency or working as an attending surgeon. :eek:

I wonder if someone knows the rate or % of surgeons (specially general surgeons, if not, any other subspecialist) who get infected???

i think this is an important issue for all of us who are thinking in a residency or for current residents.

thank you for all your inputs.

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Not really. Double-glove in the OR, be careful on the floor/in the unit when examining patients...know what the protocol is when you inevitably stick yourself with a needle while suturing. At our county hospital, a third of patients have either HIV, Hep B or Hep C. That's just how it is.
 
Blade28 said:
Not really. Double-glove in the OR, be careful on the floor/in the unit when examining patients...know what the protocol is when you inevitably stick yourself with a needle while suturing. At our county hospital, a third of patients have either HIV, Hep B or Hep C. That's just how it is.
I agree with Blade. I have been stuck once as a student and it scarey, but just keep in mind that transmission is actually fairly low. I always throw on two pairs of gloves in the trauma bay, granted they are only those thin nitrile gloves. I figure two has to be better than one, plus I can peel the outer glove off after I pull my finger out of the patient's butt from doing the rectal :)
 
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When I got stuck I looked into this question - I saw a study showing that double gloves reduce disease transmission - they hypothesized that it was the squeegee effect of the two pairs of gloves on the piercing device. (?)


for what its worth.
 
thanks for your answers. yes, you´re right, it´s a low risk (i know) but it´s still a risk. i guess, just be careful, double gloves and luck.
 
You'll get stuck. Probably once every year or two. Just know what to do (who to call) when it happens.
 
Blade28 said:
You'll get stuck. Probably once every year or two. Just know what to do (who to call) when it happens.

A study of 300 people exposed to Hep C at my institution had 8 people become positive, though none became chronic (strange). Level of exposure was all at least hollow bore needle, that had blood on the inside (ie, being used to push lidocaine does not count).

Sewing needles are much safer than iv needles.

If you take combivir within hours after getting an HIV, the transmission rate is extremely small, so small, that it is not actually known.
 
thanks siculus. that´s a good point.
 
I was stuck twice in one week during gyn surgeries, in fact, the same kind: vaginal hysterectomies. I could say more about it but it wasn't my fault, I was just holding a retractor, and yes, paying attention.

Anyway, I always double glove. Except when needles are not involved, for example, during a D&C. You just get used to the feeling of it. I'm negative so far (six month test coming up in May). I'm not that worried about it, actually, because the needle was solid- and neither patient had any disease.

But I wouldn't have known if the patient & I hadn't been tested.

Inspecting the gloves was interesting. On the first occurance, there was a hole in the outer glove but not in the inner. There was a mark on my hand when I took the second glove off. Fluid was between the gloves: this is evidence of the aforementioned squeegee affect. Pain faded within a few minutes. During the second occurance, there was also a visible hole in the glove and pain persisted for about an hour. It's easy to look for holes in gloves because they enlarge when the glove is stretched.

Both times, the surgeons told me, "she looks clean, don't worry about it." But I did. As a student, I felt strange trying to figure out whether I should press the issue or not. You feel that you should be part of the team and follow the surgeon's direction, you should defer to his/her judgement, you want a good recommendation. But then I remembered my wife- there is someone else involved here, and being cavelier affects not only myself. So I decided, in both instances, to push for the test.

It appears to me, and perhaps this is not quite right, that scrub techs are the stewards of safety and sterility in the operating room. I strongly feel that scrub techs should be charged with always activating the stick protocol when a student is involved, because students have too much at stake and many are scared to stick up for themselves.

Anyway, I'm still going into surgery even with the risk of getting infected. I just have to become a surgeon, and I feel the risks are low enough. By reporting a stick and going to the clinic, you will learn a lot about the risks and management of transmission.
 
Definitely double-glove. After my first needle-stick, I even double-glove during laparoscopic cases. We have just too many HIV/Hep B/C (+) patients to be lazy about it.
 
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