Risk of HIV and Other Blood-Borne Infections in the Cardiac Setting

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Risk of HIV and Other Blood-Borne Infections

in the Cardiac Setting

Annals of the New York Academy of Sciences 946:291-309 (2001)

Patient-to-Provider and Provider-to-Patient Transmission

VINCENZO PURO, GABRIELLA DE CARLI,

PAOLA SCOGNAMIGLIO, ROLANDO PORCASI and GIUSEPPE IPPOLITO on behalf of the Studio Italiano

Rischio Occupazionale HIVa

Dipartimento di Epidemiologia, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani"—IRCCS, 00149 Rome, Italy

Address for correspondence: Dr. Vincenzo Puro, Dipartimento di Epidemiologia, Istituto Nazionale per le Malattie Infettive "Lazzaro

Spallanzani"—IRCCS, Via Portuense, 292, 00149 Rome, Italy. Voice: +39 06 55170902; fax: + 39 06 55 82825.

puro@spallanzani.roma.it

Health care workers (HCWs) face a well-recognized risk of acquiring blood-borne pathogens in their workplace, in particular hepatitis B and C viruses (HBV/HBC) and human immunodeficiency virus (HIV). Additionally, infected HCWs performing invasive exposure-prone procedures, including in the cardiac setting, represent a potential risk for patients. An increasing number of infected persons could need specific cardiac diagnostic procedures and surgical treatment in the future, regardless of their sex or age. The risk of acquiring HIV, Hepatitis C Virus, HBV infection after a single at-risk exposure averages 0.5%, and 1-2%, and 4-30%, respectively. The frequency of percutaneous exposure ranges from 1 to 15 per 100 surgical interventions, with cardiothoracic surgery reporting the highest rates of exposures; mucocutaneous contamination by blood-splash occurs in 50% of cardiothoracic operations. In the Italian Surveillance (SIROH), a total of 987 percutaneous and 255 mucocutaneous exposures were reported in the cardiac setting; most occurred in cardiology units (46%), and in cardiovascular surgery (44%).

Overall, 257 source patients were anti-Hepatitis C Virus+, 54 HBsAg+, and 14 HIV+. No seroconversions were observed. In the literature, 14 outbreaks were reported documenting transmission of HBV from 12 infected HCWs to 107 patients, and 2 cases of Hepatitis C Virus to 6 patients, during cardiothoracic surgery, especially related to sternotomy and its suturing. The transmission rate was estimated to be 5% to 13% for HBV, and 0.36% to 2.25% for Hepatitis C Virus. Strategies in risk reduction include adequate surveillance, education, effective sharps disposal, personal protective equipment, safety devices, and innovative technology-based intraoperative procedures.

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