Hepatitis: Risks for the surgeon

Six different hepatitis viruses have now been characterized. Hepatitis B an d C are the two hepatitis infections that are of greatest concern for surge ons. Hepatitis B and C share several features that have led to this concern . Both are blood-borne infections. Both are associated with chronic infecti on ultimately leading to cirrhosis, portal hypertension, and hepatocellular carcinoma, and both can be occupational infections for the surgeon after p ercutaneous injury associated with infected blood. Chronic hepatitis B infe ction is seen in 1.25 million people in the U.S. It is associated with a tr ansmission rate to healthcare workers of 25 to 30 per cent following a holl ow needle stick injury. Five per cent of acute infections result in chronic disease. It can be effectively prevented as an occupational infection by v accination with the highly effective hepatitis B vaccine. Chronic hepatitis C infection is present in nearly 4 million people in the U.S. It has a low er rate of transmission than hepatitis B following needle stick injury, but it has a 50 to 80 per cent rate of chronic disease after acute infections. There is no vaccine for hepatitis C, and only prevention of blood exposure will avoid the risks of this occupational infection. Other hepatitis virus es are likely to be identified. Prevention of blood exposure, by the better use of barriers in the operating room and modification of surgical techniq ues, is recommended to prevent occupational infection from both known and u nknown blood-borne viruses from the surgical patient.