Acquired Hepatitis During Surgery

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Acquired Hepatitis During Surgery Essay

Acquired hepatitis during surgery has become a problem that is common among thehealthcare workers andpatients. Singularly the surgeons are at a risk of both transmitting and acquiring the hepatitis to and from their patients. However, the demerit is that a specific immunopropphylaxis for hepatitis is limited currently to protecting the against its spread thus forcing the surgeons to be on high alert and also use surgical techniques carefully. These are the only available measures that should be used to prevent the transmission of hepatitis which is relative to the surgeon. This hepatitis is viral and therefore it can be easily transmitted.Acquired Hepatitis During Surgery Essay

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The purpose of this paper is to explain what hepatitis is, what causes it during surgery, what surgical techniques can be used to prevent it, the group that is mostly affected, the treatment options, how it is transmitted and how it can be prevented.

Introduction
Hepatitis is the inflammation of the liver. The condition may progress to cirrhosis, fibrosis, liver cancer or it can be self-limiting. Viruses of hepatitis are the most common cause of hepatitis in the world but also other toxic substances, autoimmune diseases and infections can cause it (Ross, Sergei &Michael, 2000).Acquired Hepatitis During Surgery Essay

The main viruses of hepatitis are five and are referred to as types A, B, C, D and E. The five types are of the greatest concern because of the death and burden of illness they cause and the potential for epidemic spread and outbreaks. Singularly, types B and C results to chronic disease in many people and are the most common cause of liver cancer and cirrhosis (Karina, et al, 2010).
The risk of exposure of hepatitis virus starts early in the career of a surgeon and the risk is much greater compared to the most of health workers. The disease infection and transmission occurs when hollow of needle stick exposures to hepatitis e-antigen-positive blood. This is during an invasive procedure and the exposure event such as cut or puncture (Ross, Sergei &Michael, 2000).Acquired Hepatitis During Surgery Essay

The surgical techniques that should be used are such as standard precautions which include us of protective equipment in circumstances that are appropriate, adherence to meticulous standards for cleaning and reusing patient care equipment, implementation of both work practice controls and engineering controls. Another precaution is the provision of hepatitis B vaccine to the surgeons and follow up is provided to the surgeons who have had an exposure incident.

The probability of a surgeon transmitting the virus to the patient is high as compared to the patient transmitting the virus to the surgeon (Daniel and Kevin, 2003). The risk of the surgeon acquiring it was based on three factors that is: the probability of a percutaneous injury from a hepatitis infected patient transmitting hepatitis; the probability of the patient being infected; the number of percutaneous needle stick injuries the surgeon experiences.Acquired Hepatitis During Surgery Essay

Transmission during surgery can occur after muco- cutaneous contamination from blood splash, exposure to sharp objects such as steel sutures orbone fragments orneedle stick injuries. Blood splash occurs in up to 50% of all cardiothoracic operations. Among healthcare workers, surgeons are at highest risk of accidental needle sticks or sharp object injuries, a risk further increasing among the senior surgeons, performing the most complex procedures (Anderson, 2003).Acquired Hepatitis During Surgery Essay

The transmission of the hepatitis occurs when the surgeon is performing an invasive procedure and his or her serologic status is unknown. This means that the surgeon is unaware of his or her status of hepatitis and therefore he or she can likely infect the patient without knowing (Daniel and Kevin, 2003).

If the surgeon also sustains percutaneous injuries during the operation and they are not inferred. This means that the surgeon may have been infected and will perform another surgery on another patient and in the process infecting them. Another probability is that after a sharp object has caused an injury to a surgeon who has the virus and then the object having contact with the patient’s wound (Ross, Sergei &Michael, 2000). This will definitely infect the patient.Acquired Hepatitis During Surgery Essay

According to the Occupational Safety and Health Administration the hepatitis B vaccine should be given to the healthcare workers who have a higher chance of coming into contact with blood and body fluids while in the job. However, this requirement is not for the general officers who are not exposed to occupational risk.

Another precaution is that the hepatitis B vaccine series should not be restarted when the doses are delayed instead it should be continued from where it stopped. The healthcare worker should get the second dose now after that the third dose should come after eight weeks (Karina, et al, 2010). The time frame between the second and third dose should be a minimum of eight weeks and that of that of the first dose and third should be a minimum of sixteen weeks.Acquired Hepatitis During Surgery Essay

All healthcare workers who are at a risk of occupational mucosal or percutaneous exposure to body fluids or blood should be post vaccinetesting for antibody to hepatitis B surface antigen. Post vaccination should test should be done between the 1st and the 2nd month after the last dose of the vaccine.

Healthcare workers who are known to have a competent immune and have responded to hepatitis B vaccination don’t require additional active or passive immunization. Adults who respond to a dosage of 3 of hepatitis B vaccine series are protected from chronic hepatitis virus for a minimum period of 22 years (Anderson, 2003). Those who have their immune compromised will need to have hepatitis testing performed after some periods and booster doses given to them.Acquired Hepatitis During Surgery Essay

In the surgical room, their exposure prone procedures which means they are procedures that invasive where there is a risk that injury to the surgeon may lead to the exposure of the open tissues of the patient to the surgeon’s blood. The procedures include where the surgeon’s gloved hands may come to contact with the tip of needles, instruments that are sharp or tissues that are sharp such as spicules of teeth or bone inside the open cavity of the patient, confined anatomical space or wound where the fingertips or hands may not completely be visible at all times (Karina, et al, 2010).

Early detection and treatment of hepatitis virus after exposure to needle stick is associated with viral clearance which are sustained and the benefits of a surgeon going to the departments of healthcare for testing of hepatitis after sustaining a percutaneous injury is a good step in the right direction in protecting against the effects of this infection that is insidious (George, 2005).Acquired Hepatitis During Surgery Essay

Protection of the confidentiality and medical privacy of both the exposed healthcare worker and the source patient should be the main priority irrespective of the source patient’s underlying status of the infection. This should be done through managing, records of occupational exposures separately from both source patient’s medical records and employee health records (Anderson, 2003).Acquired Hepatitis During Surgery Essay
It is very important to lay emphasis on making an effort in identifying the source this is because not all exposures are linked directly to source patientwho was obvious. Also, the source patients should be clinically and epidemiologically evaluated for evidence of infection with all blood-borne pathogens that are relevant (George, 2005).

Conclusion
Understanding the history, virology, immunological responses of hepatitis infections is very important. It should be incorporated in the management strategies for surgeons and healthcare workers who are exposed occupationally to hepatitis. This can be seen by characterizing accurately the epidemiology which is nosocomial and the high level of risk that is involved with occupational exposure to hepatitis in the health care workplace.

The dangers of the healthcare worker and the surgeon being infected by hepatitis can be greatly minimised through following the stipulated recommendation in the institution. Adherence to the guidelines provided is very important and also familiarising oneself with other guidelines can help in a major way. Every healthcare and surgeon should strive in providing the best health care to their patients; they should make this their goal. They should not stick to the recommendations strictly but also periodically modify them because new information is often available as this field is one that is rapidly developing.Acquired Hepatitis During Surgery Essay

Statement on the Surgeon and Hepatitis
Online April 1, 2004
The following statement regarding the surgeon and hepatitis was originally published in the May 1995 issue of the Bulletin as the “Statement on the Surgeon and Hepatitis B Infection.” A revised statement with updated information and recommendations on hepatitis B and also inclusion of information and recommendations on hepatitis C was approved by the Board of Governors at its meeting in October 1998 and subsequently approved by the Board of Regents at its February 1999 meeting. The Board of Governors and the Board of Regents approved the most recent revisions in October 2003.

Patients and health care workers (HCWs) have great concerns about potential transmission of blood-borne pathogens, either from health care worker to patient, or from patient to health care worker. Much of this concern has been prompted by the epidemic of human immunodeficiency virus (HIV). Experience indicates that the actual risk of HIV transmission in health care settings is extremely small. The concern over HIV also focused attention on transmission of other blood-borne pathogens. As a result, there is increased awareness of the consequences to surgeons, other health care workers, and patients from the hepatitis viruses (B and C), which are transmitted by blood contact.Acquired Hepatitis During Surgery Essay

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are more efficiently transmitted blood-borne pathogens than HIV in the health care setting. An estimated 1.25 million people in the U.S. have chronic HBV infection, and more than 4 million have chronic HCV infection. Transmission of these infections to health care workers continues to occur, and approximately 250 health care workers die annually from chronic HBV infection alone.

Hepatitis B
HBV infection is detected by serologic testing for HBV antibodies. Chronic, or persistent, infection is documented by the continued presence in serum of the HBV surface antigen. In some cases of persistent infection, the hepatitis “e”-antigen, which indicates the presence of very high viral concentrations in the patient’s blood, is present and is indicative of high risk of disease transmission through blood exposure. In many centers, detection of the e-antigen has been replaced by actual counts of the number of viral units in the infected patient’s blood. High viral concentrations indicate increased risks for transmission.Acquired Hepatitis During Surgery Essay

Prevention of HBV infection is possible through immunization. The introduction of safe and effective vaccines for immunization against HBV, and the general acceptance by the professional community of the wisdom of immunization, has reduced the incidence of new cases. Immunization against HBV is effective, with more than 90 percent of vaccine recipients becoming immune after the initial inoculation series. However, many surgeons in practice remain without immunization and at risk for HBV infection. While younger surgeons have been routinely immunized, an estimated 25 to 30 percent of surgeons in practice for greater than 10 to 15 years remain at risk for infection.

The risk of exposure to HBV (and all blood-borne pathogens, including HCV) begins early in a surgeon’s career and is greater than the risk to most HCWs during the entire professional life of a surgeon. The risk of transmission of HBV from a patient to a surgeon is much greater than the risk of transmission from an infected surgeon to a patient. It is worth emphasizing that an immune surgeon cannot contract or transmit HBV infection. All but one of the reported series of HBV transmissions involved surgeons who were e-antigen positive. It is known that disease transmission and infection occur in 30 percent of hollow needlestick exposures to hepatitis e-antigen-positive blood.Acquired Hepatitis During Surgery Essay

Because HBV acute infection is often asymptomatic (70 percent of cases), there may be some surgeons who are unknowingly positive for hepatitis e-antigen and some patients doubtlessly exist whose HBV infection from exposure in the clinical setting was not detected or reported. Thus, the actual number of clusters of surgeon-to-patient transmissions is greater than the number reported in the literature. The risk of transmitting HBV from an e-antigen-positive surgeon to a patient during an invasive procedure varies with the particular procedure, the particular surgeon, and the character of the exposure event (such as puncture or cut). The actual number of surgeons who have tested positive for the e-antigen is unknown. The risk of transmission to patients is estimated from theoretical models that cover only sporadic transmission. Thus, the estimated risks are much smaller than the attack rates noted in the clusters of HBV infections that have been completely investigated. Nonetheless, these estimated risks appear to be significantly greater than the individual risks of anesthesia-associated mortality, HIV infection after transfusion of screened blood, or mortality from penicillin anaphylaxis. Acquired Hepatitis During Surgery Essay Because most individuals infected with HBV do not develop chronic or persistent infection, the risk of death from HBV is likely to be less than that from anesthesia, transfusion, or penicillin anaphylaxis. It stands to reason that surgeons should know their HBV immune status and be vaccinated if not already immune. Surgeons who have contracted HBV infection and are at risk for being e-antigen positive should obtain expert medical advice for their own care and take appropriate measures to prevent disease transmission to patients.Acquired Hepatitis During Surgery Essay

The exact mechanism of transmission from surgeon to patient is unknown, but has been thought to be from contact with the surgeon’s blood. Blood exposure from the surgeon to the patient could occur when the surgeon sustains an intraoperative injury (such as needlestick or cut), which allows the surgeon’s blood to directly touch the patient’s open tissues. Existing evidence demonstrates that prolonged knot tying or other shear injury may allow the surgeon’s virus to be transmitted to the patient. Thus, surgeon-to-patient transmission of HBV might occur even without gross blood contact. Current information about mechanisms of transmission is insufficient to know whether modifying surgical technique might prevent surgeon-to-patient transmission.Acquired Hepatitis During Surgery Essay

Hepatitis C
HCV is responsible for 80 percent of infections that were formerly known as non-A, non-B hepatitis. It is mainly transmitted through exposure to the blood of an infected individual. Intravenous drug abusers, patients receiving blood transfusions before 1991, hemophiliacs, and patients on hemodialysis are at increased risk for harboring HCV infection. Prevalence of HCV infection varies according to individual risk factors of patient populations, but is now greater than 1.5 percent of the U.S. population. HCV infection is a significant blood-borne pathogen that poses an occupational risk to surgeons.Acquired Hepatitis During Surgery Essay

Acute HCV infection is commonly asymptomatic (70 percent). Infection with HCV is detected by the identification of specific antibodies to the virus in serum. About 60 to 70 percent of acute HCV infections result in chronic, persistent infection. Patients fortunate enough to recover from an acute infection remain at risk for subsequent reinfection. Prevention of HCV infection is possible through the rigorous practice of infection control, the use of universal precautions, the use of personal protective barriers to prevent contact with potentially infected blood, and the consistent practice of behaviors to prevent needlestick and sharp instrument injury both within and outside the operating room. There is currently no immunization to prevent infection with HCV.Acquired Hepatitis During Surgery Essay

Only two reported instances of transmission of HCV virus from surgeon to patient are known. Currently, there is no indication for surgeons to take special measures to protect their patients except during acute, symptomatic HCV infection. It is prudent for surgeons known to be infected with chronic HCV infection to obtain ongoing expert medical advice so that treatment can be undertaken. Currently, treatment with interferon-alfa and Ribavirin has effectively treated the infection in 50 percent of chronically infected patients. Ongoing expert medical advice will also keep the infected surgeon abreast of developments in this area of new treatment research.Acquired Hepatitis During Surgery Essay

Recommendations
Based upon current data and recommendations issued by the Centers for Disease Control and Prevention, the College makes the following recommendations regarding hepatitis infection:

  1. Relevant to all blood-borne pathogens: Surgeons should continue to use the highest standards of infection control, involving the most effective known sterile barriers, universal precautions, and scientifically accepted measures to prevent blood exposure. This practice should extend to all sites where surgical care is rendered and should include safe handling practices for needles and sharp instruments. During every operation, maximum effort should be exerted to prevent patients’ exposure to the blood of members of the surgical team and to protect the surgical team from exposure to the blood of patients.Acquired Hepatitis During Surgery Essay
  2. Relevant to all potentially infected patients: Surgeons have the same ethical obligation to render care to hepatitis-infected patients as they have to care for other patients.
  3. Relevant to hepatitis B (HBV): Surgeons should know their HBV immunization and antibody status. Surgeons with acquired antibody from successful immunization are protected from future infection and are not infectious to their patients. Surgeons with natural antibodies to HBV have had previous infection and should know whether they are positive for the antigen of HBV. If they are negative for the HBV-surface antigen, then they do not have chronic infection and they cannot transmit the infection to patients. If they are positive for the HBV-surface antigen, they should be tested for the e-antigen of HBV. If they are positive for the HBV-surface antigen but are negative for the e-antigen, then they can continue medical practice but should consult expert medical advice for their own personal health.Acquired Hepatitis During Surgery Essay If the chronically infected HBV surgeon is positive for e-antigen or has high viral counts in his or her blood, then an expert panel should be convened to make recommendations about the continuation of clinical practice. Such a panel should consist of infectious disease specialists and surgeons who are knowledgeable in blood-borne transmission of viruses. The e-antigen-positive surgeon and the panel should discuss and agree on a strategy for protecting patients who are at risk for disease transmission. Current clinical investigation into possible antiviral therapies for chronic HBV infection may result in effective treatments in the immediate future. Chronic HBV-infected surgeons should have expert medical advice on evolving treatments for purposes of their own health.Acquired Hepatitis During Surgery Essay
  4. Relevant to hepatitis B (HBV): Surgeons who have not been immunized and have not had previous infection with HBV (that is, no antibodies to HBV), should be immunized for HBV. Documentation of seroconversion to a positive antibody test for the surface antibody for HBV should be obtained one month after completion of the immunization process. Failure to seroconvert should result in a second attempt at immunization. Failure to respond should be known to surgeons so that full use of strategies to prevent blood exposure may be employed to avoid future blood contact.Acquired Hepatitis During Surgery Essay
  5. Relevant to hepatitis C (HCV): Surgeons should know their antibody status for HCV infection. Surgeons who are negative for HCV antibodies are at risk for HCV infection and should employ all strategies to prevent blood exposure for the future. Surgeons who have chronic HCV infection have no reason to alter their practice based upon current information. They should seek expert medical advice because current medical therapy with interferon-alfa and ribavirin can successfully treat this infection in some patients.
  6. Relevant to postexposure responses and questions: Call the National Clinicians’ Postexposure Prophylaxis Hotline at 1-888/448-4911, or website www.ucsf.edu/hivcntr.Acquired Hepatitis During Surgery Essay

Summary
Immunization against HBV infection appears to be the most effective method of preventing transmission of HBV from patients to members of the surgical team, and surgeons, therefore, should be immunized against HBV. Such immunization is also the most effective way to reduce the risk of transmission of HBV from surgeons to patients. New therapies may result in treatment for the HBV-infected surgeon. Prevention of HCV infection is currently only possible through prevention of blood exposure. Surgeons should know their infection status for HCV infection so that effective therapy may be undertaken. The HBV and HCV infection status of the surgeon is personal health information and is confidential. The American College of Surgeons and its appropriate committees will continue to monitor the data and update these recommendations in the interests of protecting public safety and of protecting surgeons. Acquired Hepatitis During Surgery Essay