Engage surgeons to protect selves, patients

Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville, offered this perspective on the new guideline from the Society for Healthcare Epidemiology of America:

"The new SHEA guideline is embedded in a very long, detailed, and heavily referenced document. Without going into excruciating detail, the main difference between the previous guideline and this one is that the number of cases in which patients have been infected by providers has grown. Boiling the document down to its essentials reveals the same basic philosophy as the previous guideline. There is one paragraph embedded in the 29-page document that sums this up neatly:

"The accumulated experience and data provide reassuring evidence that the magnitude of risk for provider-to-patient transmission of HIV, HCV and HBV, although not zero, is exceedingly small. At the same time, the burdens of certain restrictions that have been placed on healthcare providers out of concern for patient safety have been disproportionately high. . .These burdens, associated with highly personal and stigmatizing diagnoses, seem unjustified in the face of an extremely low risk . . ."

"In other words it is better to sacrifice the patient's health (possibly life) in order to protect healthcare providers from discriminatory restrictions than to protect the patient's health at the expense of the healthcare worker's right to practice his or her profession. The guideline comes down squarely on the side of the healthcare worker, as if we had to make a choice. Although the philosophy underpinning the new guideline remains unchanged, we are in a very different situation today than when the guidelines were first introduced almost twenty years ago. We have an effective vaccine for hepatitis B, effective treatments for hepatitis C, and effective treatments and post-exposure prophylaxis for HIV.

"Healthcare provider-to-patient transmission of bloodborne pathogens is limited to a very narrow scope of healthcare. This is an issue affecting surgeons - and only those performing procedures that involve hands in a body cavity in proximity to sharp objects. We do not need a scattershot policy encompassing all healthcare workers. This issue needs to be worked out with surgeons.

"Today, it is no longer in the interest of surgeons not to know their bloodborne pathogen status — although some may still need to be convinced of that. Scientifically and medically we have made great advances that have yet to be fully incorporated into our policies. We have the knowledge and resources to create new policies that are not based on a choice of whom to sacrifice, whom to protect. There is no time like the present for surgeons to engage in this discussion and put forward some enlightened policy proposals that protect their patients as well as their own interests. I believe they are up to the challenge and the goal is within reach."