Acquired Hepatitis During Surgery

Abstract

Acquired hepatitis during surgery has become a problem that is common among thehealthcare workers andpatients. Singularly the surgeons are at a risk of both transmitting and acquiring the hepatitis to and from their patients. However, the demerit is that a specific immunopropphylaxis for hepatitis is limited currently to protecting the against its spread thus forcing the surgeons to be on high alert and also use surgical techniques carefully. These are the only available measures that should be used to prevent the transmission of hepatitis which is relative to the surgeon. This hepatitis is viral and therefore it can be easily transmitted.

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The purpose of this paper is to explain what hepatitis is, what causes it during surgery, what surgical techniques can be used to prevent it, the group that is mostly affected, the treatment options, how it is transmitted and how it can be prevented.

Introduction

Hepatitis is the inflammation of the liver. The condition may progress to cirrhosis, fibrosis, liver cancer or it can be self-limiting. Viruses of hepatitis are the most common cause of hepatitis in the world but also other toxic substances, autoimmune diseases and infections can cause it (Ross, Sergei &Michael, 2000).

The main viruses of hepatitis are five and are referred to as types A, B, C, D and E. The five types are of the greatest concern because of the death and burden of illness they cause and the potential for epidemic spread and outbreaks. Singularly, types B and C results to chronic disease in many people and are the most common cause of liver cancer and cirrhosis (Karina, et al, 2010).
The risk of exposure of hepatitis virus starts early in the career of a surgeon and the risk is much greater compared to the most of health workers. The disease infection and transmission occurs when hollow of needle stick exposures to hepatitis e-antigen-positive blood. This is during an invasive procedure and the exposure event such as cut or puncture (Ross, Sergei &Michael, 2000).

The surgical techniques that should be used are such as standard precautions which include us of protective equipment in circumstances that are appropriate, adherence to meticulous standards for cleaning and reusing patient care equipment, implementation of both work practice controls and engineering controls. Another precaution is the provision of hepatitis B vaccine to the surgeons and follow up is provided to the surgeons who have had an exposure incident.

The probability of a surgeon transmitting the virus to the patient is high as compared to the patient transmitting the virus to the surgeon (Daniel and Kevin, 2003). The risk of the surgeon acquiring it was based on three factors that is: the probability of a percutaneous injury from a hepatitis infected patient transmitting hepatitis; the probability of the patient being infected; the number of percutaneous needle stick injuries the surgeon experiences.

Transmission during surgery can occur after muco- cutaneous contamination from blood splash, exposure to sharp objects such as steel sutures orbone fragments orneedle stick injuries. Blood splash occurs in up to 50% of all cardiothoracic operations. Among healthcare workers, surgeons are at highest risk of accidental needle sticks or sharp object injuries, a risk further increasing among the senior surgeons, performing the most complex procedures (Anderson, 2003).

The transmission of the hepatitis occurs when the surgeon is performing an invasive procedure and his or her serologic status is unknown. This means that the surgeon is unaware of his or her status of hepatitis and therefore he or she can likely infect the patient without knowing (Daniel and Kevin, 2003).

If the surgeon also sustains percutaneous injuries during the operation and they are not inferred. This means that the surgeon may have been infected and will perform another surgery on another patient and in the process infecting them. Another probability is that after a sharp object has caused an injury to a surgeon who has the virus and then the object having contact with the patient’s wound (Ross, Sergei &Michael, 2000). This will definitely infect the patient.

According to the Occupational Safety and Health Administration the hepatitis B vaccine should be given to the healthcare workers who have a higher chance of coming into contact with blood and body fluids while in the job. However, this requirement is not for the general officers who are not exposed to occupational risk.

Another precaution is that the hepatitis B vaccine series should not be restarted when the doses are delayed instead it should be continued from where it stopped. The healthcare worker should get the second dose now after that the third dose should come after eight weeks (Karina, et al, 2010). The time frame between the second and third dose should be a minimum of eight weeks and that of that of the first dose and third should be a minimum of sixteen weeks.

All healthcare workers who are at a risk of occupational mucosal or percutaneous exposure to body fluids or blood should be post vaccinetesting for antibody to hepatitis B surface antigen. Post vaccination should test should be done between the 1st and the 2nd month after the last dose of the vaccine.

Healthcare workers who are known to have a competent immune and have responded to hepatitis B vaccination don’t require additional active or passive immunization. Adults who respond to a dosage of 3 of hepatitis B vaccine series are protected from chronic hepatitis virus for a minimum period of 22 years (Anderson, 2003). Those who have their immune compromised will need to have hepatitis testing performed after some periods and booster doses given to them.

In the surgical room, their exposure prone procedures which means they are procedures that invasive where there is a risk that injury to the surgeon may lead to the exposure of the open tissues of the patient to the surgeon’s blood. The procedures include where the surgeon’s gloved hands may come to contact with the tip of needles, instruments that are sharp or tissues that are sharp such as spicules of teeth or bone inside the open cavity of the patient, confined anatomical space or wound where the fingertips or hands may not completely be visible at all times (Karina, et al, 2010).

Early detection and treatment of hepatitis virus after exposure to needle stick is associated with viral clearance which are sustained and the benefits of a surgeon going to the departments of healthcare for testing of hepatitis after sustaining a percutaneous injury is a good step in the right direction in protecting against the effects of this infection that is insidious (George, 2005).

Protection of the confidentiality and medical privacy of both the exposed healthcare worker and the source patient should be the main priority irrespective of the source patient’s underlying status of the infection. This should be done through managing, records of occupational exposures separately from both source patient’s medical records and employee health records (Anderson, 2003).
It is very important to lay emphasis on making an effort in identifying the source this is because not all exposures are linked directly to source patientwho was obvious. Also, the source patients should be clinically and epidemiologically evaluated for evidence of infection with all blood-borne pathogens that are relevant (George, 2005).

Conclusion

Understanding the history, virology, immunological responses of hepatitis infections is very important. It should be incorporated in the management strategies for surgeons and healthcare workers who are exposed occupationally to hepatitis. This can be seen by characterizing accurately the epidemiology which is nosocomial and the high level of risk that is involved with occupational exposure to hepatitis in the health care workplace.

The dangers of the healthcare worker and the surgeon being infected by hepatitis can be greatly minimised through following the stipulated recommendation in the institution. Adherence to the guidelines provided is very important and also familiarising oneself with other guidelines can help in a major way. Every healthcare and surgeon should strive in providing the best health care to their patients; they should make this their goal. They should not stick to the recommendations strictly but also periodically modify them because new information is often available as this field is one that is rapidly developing.

References

Karina, O, MD, Per Erling Dahl, MD, PhD, Eyvind J. Paulssen, MD, PhD, Anne Husebekk, MD, PhD, Anders Widell, MD, PhD, and Rolf Busund, MD, PhD (2010). Transmission of Hepatitis C in Surgery. Journal of paediatrics, Vol. 90: 1425-31.

George, M.M. (2005). Viral hepatitis and the surgeon. Journal of viral hepatitis, Vol. 7 (1): 56-64.

Daniel, T. and Kevin, R. (2003). Risk of hepatitis C virus transmission from patients to surgeons. Journal of Surgery, Vol. 52 (9): 1333-1338.

Ross, R.S., MD; Sergei, V., PhD; Michael, R., MD (August, 2000). Risk of Hepatitis C Transmission From Infected Medical Staff to Patients. Arch Intern Med, Vol. 160 (15): 2313-2316.

Anderson, K. D. (July, 2003). Managing Occupational Risks for Hepatitis C Transmission in the Health Care Setting. Clinical Microbiology Review, Vol. 16: 546-568.

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