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{at}spallanzani.roma.it
aSee APPENDIX for list of members.
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, HCV, 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-HCV
+,
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
HCV 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
HCV. Strategies in risk reduction include adequate surveillance,
education, effective sharps disposal, personal protective equipment,
safety devices, and innovative technology-based intraoperative
procedures.
