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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 ,
Robert C. McDonald ,
Lorna A. Lynn ,
Ian Frank ,
Nicholas A. Christakis  and
J. Sanford Schwartz
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
*
Clinical Economics Research Unit, Georgetown University Medical Center, 4000 Reservoir Rd. NW, Building D, Room 392, Washington, DC 20007
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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
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 3 , March 1994 , pp. 147 - 155
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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References

1.Centers for Disease Control. Update: transmission of HIV infection during invasive dental procedures. MMWR 1991;40:377–381.Google Scholar
2.Marshall, PA, O'Keefe, JP, Fisher, SG, Caruso, AJ, Surdowski, J. Patients' fear of contracting the acquired immunodeficiency syndrome from physicians. Arch Intern Med 1990;150:1501–1506.Google Scholar
3.Scott, J. Fear of AIDS from doctors highlights views on risk. The Philadelphia Inquirer August 27,1991;A–5.Google Scholar
4.Eickhoff, T, American College of Physicians. Statement to the Centers for Disease Control February 21-22.1991.Google Scholar
5.Scott, H. The HIV infected health care worker: another policy conundrum. Ann Intern Med 1991;166:341–343.Google Scholar
6.American Medical Association. AMA statement on HIV infected physicians. January 17, 1991Google Scholar
7.Sen., McKay. Florida SB 20. HIV testing. 1993.Google Scholar
8.Rep., Ionkiert. Delaware, HB 191. An act to amend Part II. Title 16 of the Delaware Code by adding a new Chapter 29 to require that healthcare professionals be tested for AIDS and human immunodeficiency virus and that positive results be reported, that infected healthcare professionals notify their patients and be prohibited from certain practices and providing penalties for violations. 136th General Assembly, 1991.Google Scholar
9.Maryland, SB 18. Health care providers performing exposure-prone procedures: HIV testing. General Assembly Regular Session, 1992.Google Scholar
10. Rep. Wheeler, Rep. McDowell. New Hampshire HB 1404. An act relative to mandatory testing for healthcare providers and certain patients for communicable diseases. 1992.Google Scholar
11.Texas, HB 1362. Relatina to annual testing of health care providers for AIDS and HIV infection and to-the availability of those test results; providing criminal penalty. 72nd Leg., R.S. 1991.Google Scholar
12. Rep. Dannemeyer. U.S. Congress HR 2788. Kimberly Bergalis Patient and Health Provider Protection Act of 1991.1991.Google Scholar
13. Amendment 734. Appropriations for Treasury Department and U.S. Postal Service (HR 2622). Congressional Record July 11, 1991;S9778.Google Scholar
14.Nease, RF, Owens, DK. Estimating the risk posed to patients of HIV-infected surgeons and dentists performing invasive procedures. Med Decis Making 1991;11:325.Google Scholar
15.Miike, L, Ostrowsky, J. HIV in the health care workplace: background paper. Washington, DC: Office of Technology Assessment; 1991.Google Scholar
16.Gerberding, JL. Expected costs of implementing a mandatory human immunodeficiency virus and hepatitis B virus testing and restriction program for healthcare workers performing invasive procedures. Infect Control Hosp Epidemiol 1991;12:443–447.Google Scholar
17.Russo, G, La Croix, SJ. A second look at the cost of mandatory human immunodeficiency virus and hepatitis B virus testing for healthcare workers performing invasive procedures. Infect Control Hosp Epidemiol 1992;13:107–110.Google Scholar
18.Bell, DM, Martone, WJ, Culver, DH, et al. Risk of endemic HIV and hepatitis B virus transmission to patients during invasive procedures. In: Abstracts of the Seventh International Conference on AIDS. Rome, Italy: Institution Superiore di Sanita, 1991:1. Abstract 37.Google Scholar
19.Box, GEP, Hunter, WG, Hunter, JS. Statistics for Experimenters. New York, NY: John Wiley & Sons; 1978.Google Scholar
20. National HIV seroprevalence surveys: summary of results. Atlanta, GA Centers for Disease Control, 1989. U.S. Department of Health and Human Services.Google Scholar
21.Centers for Disease Control. Preliminary analysis: HIV seroprevalence of orthopedic surgeons, 1991. MMWR 1991;40:309–312.Google Scholar
22.Janssen, RS, St Louis, ME, Satten, GA, et al. HIV infection among patients in U.S. acute care hospitals: strategies for the counseling and testing of hospital patients. N Engl J Med 1992;327:445–452.Google Scholar
23.Peterson, LR, Dodd, R, Dondero, TJ. Methodologic approaches to surveillance of HIV infection among blood donors. Pub Health Rep 1990;105:153–157.Google Scholar
24.Heald, A, Ransohoff, D. Needlestick injuries among resident physicians. J Gen Intern Med 1990;5:389–393.Google Scholar
25.McGeer, A, Simor, A, Low, D. Epidemiology of needlestick injuries in house officers. J Infect Dis 1990;162:961–964.Google Scholar
26.Lowensfels, A, Wormser, G, Jain, R. Frequency of puncture injuries in surgeons and estimated risk of HIV infection. Arch Surg 1989;124:1284–1286.Google Scholar
27.American Medical Association. Physician Marketplace Statistics: Fall 1990. Chicago, IL: American Medical Association; 1990.Google Scholar
28.Henderson, D, Fahey, BJ, Willy, M, et al. Risk for occupational transmission of human immunodeficiency virus type 1 associated with clinical exposures: a prospective clinical evaluation. Ann Intern Med 1990;113:740–746.Google Scholar
29.American Medical Association Department of Physician Data Services, Division of Survey and Data Resources. Physician Characteristics and Distribution in the U.S. Chicago, IL: American Medical Association; 1990.Google Scholar
30.National Resident Matching Program. NPMP Data: April 1992. Evanston, IL: National Resident Matching Program; 1992.Google Scholar
31.McNeill, JG, Brundage, JE, Gardner, LI, et al. Trends of LUV seroconversion among young adults in the U.S. Army, 1985 1989. JAMA 1991;265:1709–1714.Google Scholar
32.Centers for Disease Control. Public Health Service guidelines for counselling and antibody testing to prevent HIV infection and AIDS. MMWR 1987;36:509–515.Google Scholar
33.Centers for Disease Control. Interpretation and use of the Western Blot assay for serodiagnosis of HPV-1 infected individuals. MMWR 1989; (suppl 7): 1–7.Google Scholar
34.Schwartz, JS, Dans, P, Kinosian, B. Human immunodeficiency virus test evaluation, performance, and use. JAMA 1988;259:2574–2579.Google Scholar
35.Schwartz, JS, Kinosian, B, Pierskalla, W, Lee, H. Strategies for screening blood for human immunodeficiency virus antibody. JAMA 1990;264:1704–1710.Google Scholar
36.Sloand, EM, Pitt, E, Chiarello, RJ, Nemo, GJ. HIV testing: state of the art. JAMA 1991:266:2861–2866.Google Scholar
37.Horsburg, CR, Ou, C-Y, Jason, J, et al. Duration of human immunodeficiency virus infection before detection of antibody. Lancet 1989;9:637–640.Google Scholar
38.Centers for Disease Control. Update: investigations of patients who have been treated by HIV-infected health care workers. MMWR 1992;41:344–346.Google Scholar
39.Danila, RN, MacDonald, KL, Rhame, FS, et al. A look-back investigation of patients of an HIVinfected physician: public health implications. NEngl J Med 1991;325:1406–1411.Google Scholar
40.National Center for Health Statistics. National Hospital Discharge Survey, 1988. Hyattsville, MD: Department of Health and Human Services; 1990.Google Scholar
41.Cumming, PD, Wallace, EL, Schorr, JB, Dodd, RY. Exposure of patients to human immunodeficiency virus through the transfusion of blood components that test antibody-negative. N Engl J Med 1989:321;941–946.Google Scholar
42.Hedlund, K, Spencer, J, Schalla, W, Johnson, L, Fehd, R. Estimating public costs of LUV counseling and testing, USA Presented at the Sixth International Conference on AIDS. San Francisco, California, June 20-24, 1990.Google Scholar
43.Polish, LB, Shapiro, CN, Bauer, F; et al. Nosocomial transmission of hepatitis B virus associated with the use of a spring-loaded finger-stick device. N Engl J Med 1992;326:721–725.Google Scholar