[HCV, HBV and HIV infections: risk for surgeon and staff. Results and consequences of routine screening in emergency patients].
BACKGROUND
Trauma and emergency surgeons (S) are in contact with high-risk patients (P) infected with HBV, HCV, and HIV without knowing which P is and which is not infected. The aim of this paper was to analyze routine screening (SCR) in trauma care.


METHODS
Microparticle enzyme immunoassays (MEIA) (Abbott Axym system) were analyzed from routine blood samples: HBsAg (V2), HCV version 3.0, HIV 1/2gO. All positive or uncertain samples were confirmed with ELISA/PCR.


RESULTS
From January 2002 to October 2002 a total of 1074 emergency P were examined. The results were available within 50 min after admittance to the emergency room. In 53 of 1074 (4.9%) the MEIA was positive or in threshold margins (LV): HBV 15 P plus 3 LV (9 secured by ELISA/PCR), prevalence (PV) 0.84%. HCV 34 P plus 1 LV (31 secured with ELISA/PCR), PV 2.9%. HIV 2 P, PV 1.86 per thousand, 1 in co-infection with HCV, 1 with HBV. Of 42 infections, 21 were unknown before screening, and in 5 P the S suspected an infection. After screening, nine surgical procedures were changed to safer procedures.


CONCLUSIONS
MEIA is a good tool for quick SCR of HCV, HBV, and HIV in emergency surgery (ES). When the infection is known the S is more aware to perform only safe procedures during surgery (no touch technique) or to use more protective devices (e.g., fluid shield, double gloves). Our results indicate that surgeons and nurses in ES are exposed four to six times more often to infection with HCV, HBV, and HIV than represented by officially published data. We recommend routine SCR of HBV, HCV, and HIV for all P in ES. Prevention procedures are discussed.
Dresing
K
K
Klinik für Unfallchirurgie, Plastische und Wiederherstellungschirurgie, Universitätsklinik Göttingen. klaus.dresing@med.uni-goettingen.de
Pouwels
C
C
Bonsack
S
S
Oellerich
M
M
Schwörer
H
H
Uy
A
A
Stürmer
K M
KM
D000293:Adolescent; D000328:Adult; D000368:Aged; D004630:Emergencies; D004797:Enzyme-Linked Immunosorbent Assay; D013502:General Surgery; D005932:Gloves, Surgical; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control / Q000635:transmission*; D006509:Hepatitis B / Q000175:diagnosis / Q000517:prevention & control / Q000635:transmission*; D006526:Hepatitis C / Q000175:diagnosis / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007124:Immunoenzyme Techniques; D017758:Infectious Disease Transmission, Patient-to-Professional; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009726:Nurses; D012307:Risk Factors