SHEA identifies invasive, exposure-prone procedures

New Society for Healthcare Epidemiology of America (SHEA) guidelines for health care workers infected with bloodborne viruses include the following procedures at greatest risk of transmission to patients.1

Category III: Procedures for which there is definite risk of bloodborne virus transmission or that have been classified previously as "exposure-prone"

• General surgery, including nephrectomy, small bowel resection, cholecystectomy, subtotal thyroidectomy other elective open abdominal surgery

• General oral surgery, including surgical extractions, hard and soft tissue biopsy (if more extensive and/or having difficult access for suturing), apicoectomy, root amputation, gingivectomy, periodontal curettage, mucogingival and osseous surgery, alveoplasty or alveoectomy, and endosseous implant surgery guideline on HCWs infected with HBV, HCV, and/or HIV

• Cardiothoracic surgery, including valve replacement, coronary artery bypass grafting, other bypass surgery, heart transplantation, repair of congenital heart defects, thymectomy, and open-lung biopsy

• Open extensive head and neck surgery involving bones, including oncological procedures

• Neurosurgery, including craniotomy, other intracranial procedures, and open-spine surgery

• Non-elective procedures performed in the emergency department, including open resuscitation efforts, deep suturing to arrest hemorrhage, and internal cardiac massage

• Obstetrical/gynecological surgery, including cesarean delivery, hysterectomy, forceps delivery, episiotomy, cone biopsy, and ovarian cyst removal, and other transvaginal obstetrical and gynecological procedures involving hand-guided sharps

• Orthopedic procedures, including total knee arthroplasty, total hip arthroplasty, major joint replacement surgery, open spine surgery, and open pelvic surgery

• Extensive plastic surgery, including extensive cosmetic procedures (eg, abdominoplasty and thoracoplasty)

• Transplantation surgery (except skin and corneal transplantation)

• Trauma surgery, including open head injuries, facial and jaw fracture reductions, extensive soft-tissue trauma, and ophthalmic trauma

• Interactions with patients in situations during which the risk of the patient biting the physician is significant; for example, interactions with violent patients or patients experiencing an epileptic seizure

• Any open surgical procedure with a duration of more than 3 hours, probably necessitating glove change.


1. Henderson DK, Dembry L, Fishman NO, et al. SHEA guideline for management of health care workers who are infected with hepatitis B virus, hepatitis C virus, and/or human immunodeficiency virus. Infect Control Hosp Epidemiol 2010; 31:203-232.