Officials at the Department of Health have no
plans to introduce routine hepatitis C tests for healthcare workers
after the announcement last week that a surgeon had
infected a woman patient with the bloodborne virus. The
incident is thought to be the third documented case of a
patient being infected with the virus by a surgeon.
The surgeon, who had worked at the Pilgrim
Hospital in Boston, Lincolnshire, since 1997, is on sick leave.
A sample of his blood taken two years ago, before the
woman's operation, was found to be positive for the virus.
Since the case came to light, another blood sample, taken
in 1993 by the hospital that then employed the
surgeon, the Torbay District General Hospital, has also been found
to be infected.
About 1600 women who have been operated on by
the surgeon since then are being contacted and offered tests.
The Department of Health says that 0.5%of the
population are estimated to be infected with hepatitis C virus. In
the United States, national survey data suggest that the
prevalence there may be about 1.8%making it the country's
most common chronic bloodborne infection. The British
blood supply has been screened for the virus since 1991.
Some types of surgery increase the risk that
surgeons will receive a sharps or needlestick injury, thus
potentially exposing the patient to their blood. The women
to be contacted in the latest incident have all had
gynaecological procedures that are known as "exposure
prone," such as hysterectomy and caesarean section.
According to a report by the Senate of Surgery of
Great Britain and Ireland, which represents the surgeons' royal
colleges and others, gynaecology is one of the highest
risk specialties for surgeon injury, with sharps injuries
occurring in 10%of all procedures and up to 21%of vaginal
hysterectomies.
The two previous documented cases of surgeon to
patient transmission of hepatitis C virus involved cardiac surgery,
another "exposure prone" specialty.
A spokeswoman for the Department of Health said
that its advisory committee on hepatitis did not currently believe
that testing of health workers for the virus was warranted
because "the risk is so small."
Similarly, the United States does not recommend
routine testing of health workers for the virus, saying that
prevalence of infection in health workers is no higher
than in the general population.
James Johnson, chairman of the Joint Consultants
Committee (a committee comprising representatives from the BMA and
the medical royal colleges), argues that complete safety
could never be guaranteed even if surgeons were tested for
the virus four times a year.
Between one test and another, a surgeon could
become infected and infect his or her patients. The risk appears to
be low, and the costs of testing might not be justifiable,
he said. "You are talking big money here, and we can
never make it totally safe."
A report by the US Centers for Disease Control and
Prevention says that the average incidence of infection with
hepatitis C virus after unintentional needlestick or
sharps exposure from a source positive for the virus, is
1.8%.
In the case of hepatitis B virus, which is thought
to be more infectious, the Department of Health recommends testing
for all health workers and immunisation. The department
currently recommends that surgeons positive for both the
hepatitis B surface and e antigens should avoid performing
exposure prone procedures. Surgeons carrying out exposure
prone procedures have to show that they are not e antigen
positive or that they are immune.
These guidelines are currently under revision
after reports of patients becoming infected by surgeons who did not
express these antigens.
