Four Infected With HIV
During Simple Surgery -
Dirty Instruments Blamed
By Charlene Laino
MSNBC Health Editor
"In the past 10 years, over 50,000 health care workers have been infected by HIV and hepatitis due to inadvertent needle-stick injuries."
CHICAGO, Feb. 2 - In a finding that has wide-ranging public health implications, researchers reported here Tuesday that they now have molecular proof that four Australians were accidentally infected with the AIDS virus during routine outpatient surgery. The reason is almost certainly a failure on the surgeon's part to properly sterilize instruments between procedures, they said.
MOLECULAR TESTING proved that the patients, all of whom had surgery on the same day in Nov. 1989, could only have been infected by a fifth patient, said Nitin Saksena of the Center for Virus Research at Westmead Hospital in Westmead, Australia.
The infections represent the third cluster in the world in which HIV was transmitted from person to person via surgical procedure. But in the other two cases - one in Florida and the other in France - the surgeon is thought to have directly infected his patients, while in this case, the doctor probably facilitated transmission by using dirty instruments, Saksena said.
The research follows the lines of a medical detective story. According to Saksena, one of the four infected patients was a teen-age girl who denied engaging in any of the risky behaviors associated with contracting HIV. When she tested positive for the virus during a routine blood test in 1992, her doctors were at first stumped.
"Then they asked if she could have been exposed to infected blood any other way - through a wound or during surgery," the Australian researcher said here at the Sixth Conference on Retroviruses and Opportunistic Infections. "And it turned out that the only procedure that involved skin penetration - and exposure of the patient's blood - was at the dermatology private clinic."
The next step, he said, was to pore over the clinic's medical records, which revealed that 17 patients had had surgery on the same day as the teenager. Of the 16 that came in for HIV testing, three - all men, ranging in age from 50 to 70 - also proved to be infected.
"Obviously, something was wrong," Saksena said. "You don't expect one in four patients at a dermatology clinic to be infected with HIV." They next went to the surgeon, who tested HIV-negative. While the surgeon said that he followed standard sterilization control procedures, Saksena said that he feels strongly that "a breakdown in control procedures is the likely cause." The surgeon was suspended for two years, but is again practicing.
Arm yourself against AIDS
Meanwhile, another of the 17 patients died from AIDS. Saksena said he is certain that this patient was the original source of all the infections - "it's the only possible explanation" - although he did not have a blood sample on which he could perform molecular testing.
What he did have, however, was blood samples from the four newly infected patients. And intensive testing of various parts of their viruses revealed they were indeed the same strain, "confirming that transmission took place from a single source," Saksena said.
Dr. Harold Jaffe, an AIDS researcher at the Centers for Disease Control and Prevention in Atlanta, said the findings point to the need for rigorous adherence to control procedures such as hand-washing, wearing gloves and sterilization of instruments.
"We see inadvertent needle-sticks of blood from infected persons all too often," he said. In the past 10 years, over 50,000 health-care workers have been infected by HIV and hepatitis due to inadvertent needle-stick injuries. And every year, between 150 to 200 workers die because of needle sticks.