title: Prevalence of blood-borne pathogens in an urban, university-based general surgical practice.
abstract: OBJECTIVE
  To measure the current prevalence of blood-borne pathogens in an urban, university-based, general surgical practice.
  
  
  BACKGROUND
  Human immunodeficiency virus (HIV), hepatitis B, and hepatitis C represent significant occupational hazards to the surgeon. While the incidence of these blood-borne pathogens is increasing in the general population, little is known about the current prevalence of these exposures among patients presenting for surgery.
  
  
  METHODS
  We studied 709 consecutive operative cases (July 2003 to June 2004) in a university practice that provides all inpatient, emergency department, and outpatient consultative general surgical services. Trauma cases and bedside procedures were excluded. Data collected included HIV, hepatitis B and C test results, type of operation, age, sex, and history of intravenous drug use.
  
  
  RESULTS
  Testing for blood-borne pathogens was performed in 53% (N = 373) of 709 patients based on abnormal liver function tests, neutropenia, history of IV drug use, or patient request. Thirty-eight percent of all operations (142/373) were found to involve a blood-borne pathogen when tested: HIV (26%), hepatitis B (4%), hepatitis C (35%), and coinfection with HIV and hepatitis C (17%). Forty-seven percent of men tested positive for at least 1 blood-borne pathogen. Seventy-three different types of operations were performed, ranging from Whipple procedures to amputations. Soft-tissue abscess procedures 48% (34/71) and lymph node biopsies 67% (10/15) (P < 0.01) were most often associated with blood-borne pathogens. Infections were more common among men (P < 0.01), patients 41 to 50 years of age (P < 0.01), and patients with a history of intravenous drug use (P < 0.01).
  
  
  CONCLUSIONS
  HIV and hepatitis C infections are common in an urban university general surgical practice, while hepatitis B is less common. In addition, certain operations are associated with significantly increased exposure rates. Given the high incidence of these infections, strategies such as sharpless surgical techniques should be evaluated and implemented to protect surgeons from blood-borne pathogens.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Weiss
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.forename: Theresa
authors.initials: T
authors.lastname: Wang
authors.forename: Dora
authors.initials: D
authors.lastname: Syin
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: David
authors.initials: D
authors.lastname: Chang
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
mesh_terms: D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D017848:Blood-Borne Pathogens; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006509:Hepatitis B / Q000453:epidemiology* / Q000635:transmission; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission; D006785:Hospitals, University; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D008297:Male; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D016635:Universal Precautions; D014505:Urban Population / Q000706:statistics & numerical data*