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Sharpless surgical techniques include laparoscopy, electrocautery
and skin clips or glue to replace scalpel incisions and sewing.
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While the incidence of disease from HIV and hepatitis is
increasing in the United States, little is known about their
prevalence in patients undergoing surgery. Now, researchers
have shown that nearly 40 percent of surgeries at The Johns
Hopkins Hospital occur in patients who tested positive for a
bloodborne germ.
"While these rates are alarming, they are not entirely
unexpected. General precautions have been in effect for some time to
prevent the spread of disease to health care workers in the
operating room," said Martin A. Makary, M.D., assistant professor of
surgery and public health at Johns Hopkins and lead author of a
report in the May 2005 issue of the Annals of Surgery.
"Given the high incidence of these infections, however, we have
developed new strategies such as 'sharpless' surgery-a surgical
technique which uses high-technology alternatives to needles and
knives. We advocate using these techniques whenever possible in
high-risk settings to further protect health care workers from
accidental transmission," added Makary.
Sharpless surgical techniques include laparoscopy, electrocautery
to replace scalpel incisions, and skin clips or glue instead of
sewing to close or repair wounds.
Previous studies have shown that health care workers are injured
in about 7 percent of operations. As many as 87 percent of surgeons
will receive an injury that breaks the skin -- thus allowing for
possible disease transmission - at some point in their career. There
are an estimated 40,000 new cases of HIV each year, and hepatitis C
is increasing at an even faster rate, according to the report. The
study concludes that by studying the rates of HIV and hepatitis B
and C among patients presenting for surgery, a more accurate
incidence of disease is measured within a community, bypassing the
selection bias of traditional statistics of known infected patients
presenting to primary care clinics. Furthermore, the authors report
that blood-borne pathogens are associated with certain types of
operations.
The researchers also found that the operations associated with
the greatest risk of infection - lymph-node biopsy, soft-tissue-mass
excision and abscess-drainage cases - were often assigned to the
most inexperienced surgeons-in-training, placing them at greatest
risk.
"Sharpless surgical techniques combined with traditional
precautions and early education for surgery trainees are the most
practical ways to reduce the risk of infection to health care
workers," said Makary.
The researchers studied 709 consecutive adult general surgery
operations performed between July 2003 and June 2004 in the
community surgical service at The Johns Hopkins Hospital including
inpatient, emergency department and outpatient surgical procedures.
Data were collected on HIV, hepatitis B and hepatitis C test
results, type of operation, age, sex and history of intravenous drug
use.
The researchers found that 38 percent of all operations involved
a bloodborne pathogen, and almost half (47 percent) of all men
tested positive for at least one infection. HIV accounted for 26
percent of infections, hepatitis B for 4 percent, hepatitis C for 35
percent, and co-infection with HIV and hepatitis C accounted for 17
percent of infections. In addition, bloodborne pathogen infection
was found in up to 65 percent of patients with a history of
intravenous drug use and in as many as 71 percent of patients
undergoing a soft-tissue abscess procedure or lymph-node biopsy.
While the patients in this study tend toward low socioeconomic
status and increased substance use, most university hospitals in the
United States are located in urban areas and serve a similar patient
population, added Makary.
Other authors on the report are Eric S. Weiss, Theresa Wang, Dora
Syin, Peter Pronovost, David Chang and Edward Cornwell III.
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