Surgeons who test positive for hepatitis C should be transferred to low risk duties.
HCV-infected surgeons may transmit HCV to patients during exposure-prone procedures. Current UK policy allows HCV-infected surgeons to practise unrestricted unless they have been associated with transmission, and, at present, surgeons are not routinely tested for HCV infection. The overall outcome for patients exposed to an HCV-infected surgeon may be worse than that for patients exposed to a surgeon who is an HBeAg negative carrier of HBV. However, because most acute HCV infections are anicteric, surgeon associated HCV transmission is less likely to be detected by surveillance. Surgeons have been observed to sustain intraoperative injuries in around 5% of procedures. If surgeons were required to report every intraoperative injury and to be tested to determine whether the patient could have been exposed to HCV, compliant surgeons would be tested for HCV at least annually. Investigations of HBV transmission, however, have suggested that patients may be exposed to a surgeon's blood in as many as 1 in 5 procedures, and that much surgeon to patient transmission is the result of inapparent intraoperative exposure, which the surgeon does not recognise. Thus, requiring surgeons to report intraoperative injuries would not identify all those patients who might have been exposed to HCV, and, since no vaccine or prophylaxis is available, could not prevent infection. A more satisfactory alternative is regular testing of surgeons for HCV, coupled with restriction of practice of those found to be infected.
Heptonstall
J
J
16A Rochester Square, London NW1 9SA, UK.
D006526:Hepatitis C / Q000175:diagnosis / Q000635:transmission*; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*