Review Question - QID 214160

Orthopedic surgeons who are actively seropositive for HIV, Hepatitis B, or Hepatitis C are obligated to inform their patients at the time of scheduling for an exposure-prone procedure.

Transmission of blood-borne pathogens from both patient-to-provider and from provider-to-patient has been reported in orthopedic surgery. The risk of transmission from a needle stick injury is reported to be ~0.3% for HIV, ~1.8% in Hepatitis C, and between 6-30% for Hepatitis B (30% if the source is positive for HBeAg, but ~6% if the source is HBeAg-negative). While provider-to-patient transmission of blood-borne pathogens is thought to be extremely low (much lower than the risk of patient-to-provider), it can still occur during exposure-prone procedures. The CDC has defined an exposure-prone procedure as one in which "palpation of a needle tip in a body cavity or the simultaneous presence of a provider's fingers and a needle or other sharp object in a poorly visualized or highly confined anatomic site." As such, it is recommended that physicians with HIV, HepB, and HepC disclose seropositivity to patients while scheduling them for an elective exposure-prone procedure.

Lot et al. performed an epidemiologic investigation on the possible transmission of HIV to patients from an orthopedic surgeon with HIV. The authors reviewed the results of the French Ministry of Health offering HIV testing to 983 patients who had been operated on by an orthopedic surgeon in whom AIDS was recently diagnosed. Of the 983 patients, only 1 patient was HIV positive. It was noted that the 1 HIV-positive patient had tested negative prior to undergoing a total hip arthroplasty performed by the surgeon in 1992 and had no other identified risk for HIV exposure. Molecular analysis indicated that the viral sequences obtained from the surgeon and the HIV-infected woman were closely related. The authors concluded that an HIV-infected surgeon may have transmitted HIV to one of his patients during surgery.

AAOS Advisory statement on blood-borne pathogens can be accessed here: https://www5.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/advistmt/1018%20Preventing%20the%20Transmission%20of%20Bloodborne%20Pathogens.pdf

Incorrect Answers:
Answers 1, 2, 4, and 5: Orthopedic surgeons who are actively seropositive for HIV, Hepatitis B, or Hepatitis C are obligated to inform their patients at the time of scheduling for an exposure-prone procedure.