Risk of hepatitis C transmission from infected medical staff to patients -Model-based calculations for surgical settings

Context: Concern is increasing in both the medical community and among the general public about the possible transmission of hepatitis C virus (IICV) from infected health care workers to their patients. Until now, no reliable estimates for the risk of such transmission exist. Objective: To estimate the probability of HCV transmission from a surgeon t o a susceptible patient during invasive procedures. Design: A model consisting of 4 probabilities was used: (A) the probability that the surgeon is infected with HCV, (B) the probability that the surgeo n might contract percutaneous injuries, (C) the probability that an HCV-con taminated instrument will recontact the wound, and (D) the probability of I ICV transmission after exposure. Values for the calculations were taken fro m published studies. Results: When the surgeon's HCV status is unknown, the risk of HCV transmis sion during a single operation is 0.00018%+/-0.00002% (mean+/-SD). If the s urgeon is HCV RNA positive, this risk equals 0.014%+/-0.002%. The likelihoo ds of transmission in at least 1 of 5000 invasive procedures performed by a surgeon during 10 years are 0.9%+/-0.1% (HCV status unknown) and 50.3%+/-4 .8% (HCV RNA positive), respectively. Conclusions: The calculated risks for HCV transmission from a surgeon to a susceptible patient during a single invasive procedure are comparable to th e chance of acquiring HCV by receiving a blood transfusion. These figures c ould provide a basis for further discussions on this controversial subject and might also be relevant for future recommendations on the management of HCV-infected health care workers.