March 2001
Volume 65 |
Number 3
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| Infection
Control Recommendations: Their Importance to the Practice
of Anesthesiology |
Arnold J. Berry, M.D.
Chair Committee on Occupational Health
When appropriate infection control precautions are used, the
risk of occupational transmission of bloodborne pathogens such
as hepatitis C virus (HCV) from patients to anesthesiologists
is relatively low. Additionally, since the risk of occupational
HCV transmission to patients is quite low, HCV-infected anesthesiologists
have been permitted to continue to practice if they follow strict
aseptic techniques and standard precautions.1-3
The importance of compliance with these infection control recommendations
is emphasized by a recent report from Germany.4
Using epidemiologic evidence and molecular viral typing,
investigators demonstrated occupational transmission of HCV from
an infected patient to an anesthesiologist's assistant who subsequently
transmitted the virus to five patients.4 The
authors describe the tasks performed by the anesthesiologist's
assistant as follows: he was almost entirely responsible for the
administration of general anesthesia, including the preparation
of narcotic drugs, the placement of venous and arterial catheters,
the intubation of the patients and the subsequent artificial respiration.4
Questioning of the assistant revealed that he did not routinely
follow standard precautions. He usually did not wear gloves, because
he claimed that they diminished his sense of touch and therefore
impaired his work.4 The portal of
entry of the virus from the initial HCV-infected patient appears
to be a thumbnail-sized wound on the assistant's finger that repeatedly
bled and continued to weep when bandages were no longer used on
the site. After infection, but prior to developing acute, icteric
hepatitis C, the anesthesiologist's assistant appears to have
transmitted the virus to five patients through an unknown mechanism,
although it was most likely related to blood or secretions associated
with the open finger lesion.
This report clearly demonstrates the potential for occupational
HCV transmission both from and to patients via tasks performed
by anesthesiologists. The disregard of appropriate aseptic techniques
and the failure to use standard precautions likely were responsible
for the adverse outcomes. In 1992, the Task Force on Infection
Control of the Committee on Occupational Health published Recommendations
for Infection Control for the Practice of Anesthesiology that
contains specific suggestions for the use of standard precautions
and strict aseptic techniques by anesthesiologists.5
The second edition of the booklet containing current infection
control recommendations can be obtained from the ASA's Publications
Department or from its Web site at www.ASAhq.org/ProInfo/Infection/Infection_TOC.htm.
The importance of these recommendations for anesthesiologists'
welfare and for patient safety is highlighted by the current report.
References:
1. Centers for Disease Control and Prevention.
Recommendations for prevention and control of hepatitis C virus
(HCV) infection and HCV-related chronic disease. MMWR. 1998; 47(No.RR-19):19.
2. Centers for Disease Control and Prevention.
Guidelines for prevention of transmission of human immunodeficiency
virus and hepatitis B virus to health-care and public-safety workers.
MMWR. 1989; (No.S-6):38.
3. Garner JS. Hospital Infection Control Practices
Advisory Committee. Guideline for isolation precautions in hospitals.
Infect Cont Hosp Epidemiol. 1996; 17:54-80.
4. Ross RS, Viazov S, Gross T, et al. Transmission
of hepatitis C virus from a patient to an anesthesiology assistant
to five patients. N Engl J Med. 2000; 343:1851-1854.
5. Task Force on Infection Control. Recommendations
for Infection Control for the Practice of Anesthesiology. 1st
ed. Park Ridge, IL: American Society of Anesthesiologists; 1992.
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Arnold
J. Berry, M.D., is Professor of Anesthesiology, Emory University
School of Medicine, Atlanta, Georgia. |
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