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Screening Surgeons for HIV Infection: Assessment of a Potential Public Health Program

Published online by Cambridge University Press:  02 January 2015

Kevin A. Schulman
Affiliation:
Clinical Economics Research Unit, Division of General Infernal Medicine, Georgetown University Medical Center, Washington, DC
Robert C. McDonald
Affiliation:
Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
Lorna A. Lynn
Affiliation:
Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Ian Frank
Affiliation:
Section of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Nicholas A. Christakis
Affiliation:
Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
J. Sanford Schwartz
Affiliation:
Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

Abstract

Objective:

To develop a model to assess the impact of a program of testing surgeons for human immunodeficiency virus (HIV) on the risk of HIV acquisition by their patients.

Design:

A Monte Carlo simulation model of physician-to-patient transmission of human immunodeficiency virus (HIV) infection using three different rates of physician-to-patient transmission per percutaneous exposure event (0.15%, 0.3%, 0.6%). Data from the model were developed from a review of the medical literature and from subjective probability estimates when data were not available. We used this model to estimate on a national basis the annual number of cases of HIV transmission from surgeons to patients with and without surgeon testing and practice limitations.

Results:

The annual number of transmitted cases would range from 0.5 ( 0.3), assuming a surgeon HIV prevalence of 0.1% and a surgeon-to-patient transmission rate of 0.15%, to 36.9 (±11.6), assuming a surgeon HIV prevalence of 2% and a surgeon-to-patient transmission rate of 0.6%. After one screening cycle, a mandatory screening program would be expected to reduce the annual transmissions to 0.05 (± 0.03) and 3.1 ( 1. 1), respectively.

Conclusion:

Patients are at low risk of acquiring HIV infection from an infected physician during an invasive procedure. The potential costs of such a program extended beyond the costs of testing and counseling. In communities with high HIV prevalence, screening surgeons and limiting their practices may decrease patient access to care. A disability insurance program also would be required to protect surgeons and trainees performing invasive procedures. Screening surgeons for HIV infection would be a costly undertaking that would reduce but not completely eliminate this risk.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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