SCREENING SURGEONS FOR HIV-INFECTION - ASSESSMENT OF A POTENTIAL PUBLIC-HEALTH PROGRAM

OBJECTIVE: To develop a model to assess the impact of a program of tes ting surgeons for human immunodeficiency virus (HIV) on the risk of HI V acquisition hy their patients. DESIGN: A Monte Carlo simulation mode l of physician-to-patient transmission of human immunodeficiency virus (HIV) infection using three different rates of physician-to-patient t ransmission per percutaneous exposure event (0.15%, 0.3%, 0.6%). Data from the model were developed from a review of the medical literature and from subjective probability estimates when data were not available . We used this model to estimate on a national basis the annual number of cases of HIV transmission from surgeons to patients with and witho ut surgeon testing and practice limitations. RESULTS: The annual numbe r of transmitted cases would range from 0.5 (+/- 0.3), assuming a surg eon HIV prevalence of 0.1% and a surgeon-to-patient transmission rate of 0.15%, to 36.9 (+/- 11.6), assuming a surgeon HIV prevalence of 2% and a surgeon-to-patient transmission rate of 0.6%. After one screenin g cycle, a mandatory screening program would be expected to reduce the annual transmissions to 0.05 (+/- 0.03) and 3.1 (+/- 1.1), respective ly. CONCLUSION. Patients are at low risk of acquiring HIV infection fr om an infected physician during an invasive procedure. The potential c osts of such a program extended beyond the costs of testing and counse ling. In communities with high HIV prevalence, screening surgeons and limiting their practices may decrease patient access to care. A disabi lity insurance program also would be required to protect surgeons and trainees performing invasive procedures. Screening surgeons for HIV in fection would be a costly undertaking that would reduce but not comple tely eliminate this risk.