Risk of HIV transmission from patients to surgeons in the era of post-exposure prophylaxis

The HIV prevalence, among patients either undergoing, or with the potential to undergo, surgery were estimated using data from unlinked anonymous HIV surveys of patients in Glasgow hospitals during 1992-1997 in order to quant ify the risk of surgeons acquiring HIV occupationally in the era of postexp osure prophylaxis (PEP) availability. A range of prevalence rates was appli ed to data on other factors influencing risk; these comprized, i) the proba bility of a percutaneous injury from a sharp instrument used on an HIV infe cted patient resulting in HIV transmission, ii) the number of injuries sust ained and iii) whether or not PEP was administered. On the basis of, for ex ample, a surgeon sustaining three percutaneous injuries over 12 months and not taking PEP after each, the annual risks ranged from 1 in 2 000 000 for urological/renal surgeons to 1 in 200 000 for those performing general surg ery/ENT/gynaecological procedures. The administration of PEP after each inj ury would reduce these rates to 1 in 10 000 000 and 1 in 1 000 000 respecti vely. The risk of surgeons acquiring HIV occupationally in a city which has an HIV prevalence typical of most urban areas in the UK, is 'minimal' or ' negligible'. In the context of such low risk and our limited knowledge of t he adverse effects of PEP, the risk assessment to decide whether or not to give PEP should be well informed and consistent. Current guidelines to help physicians and affected healthcare workers in their decision making need t o be improved. (C) 2000 The Hospital Infection Society.