Transcript Spinal surgery for HIV-infected patients: Experience in Taichung

Spinal surgery for HIV-infected
patients: Experience in Taichung
Veterans General Hospital
Meng-Ting Wu, Hsi-Kai Tsou, Wen-Yu Cheng,
Chiung-Chyi Shen
Department of Neurosurgery, Veterans General
Hospital-Taichung, Taichung, Taiwan
The HIV/AIDS Epidemic
From 行政院愛滋病防治推動委員會 2006/06/02
Risk of transmission from patient to
healthcare workers
Patient
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Name: 陳張x華
Age: 58 year(s) old
Gender: 女
手術日期 : 2005/03/03
Pre-operative diagnosis :
1. R/O C5-6 epidural
abscess
2. R/O C5-6 spinal tumor
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Post-operative diagnosis :
Ruptured disc, C5-6
Name: 謝x宏
Age: 28 year(s) old
Gender: 男
手術日期 : 2006/02/05
Pre-operative diagnosis :
Spinal injury with
compression fracture,L2-4
with myelopathy
Post-operative diagnosis :
Spinal injury with
compression fracture,L2-4
with myelopathy
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PRE-OP
POST-OP
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Risk After Occupational Exposure
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The risk of HIV transmission after injury with a
hollow needle contaminated with HIV-infected
blood is 0.3%. The risk after injury with a suture
needle is unknown.
16-fold needle injury to deep soft tissue
6-fold  if the patient has advanced AIDS (and
presumably a high viral titer).
5-fold  visible blood on the needle or involved
placement of the needle in an artery or vein
J Hepatol. 1997 Jul;27(1):18-24.
Intraoperative Exposure
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Decrease operation time: The risk of injury is
highest during procedures lasting longer than 2.5
to 3.0 hours, especially when blood loss exceeds
250 to 300 ml. J Neurosurg 1990;73:651-660
Minimize manual contact with a sharp object
Using "no-touch" techniques can prevent injuries
during passage of needles and other sharp
objects from person to person.
Blunt suture needles can be used for many
procedures, and have been shown to prevent
intraoperative needle injuries. New York City. MMWR 1997;46.
Double Gloving
Advantage: gloves constructed of
monofilament polymers resistant to tears
 Disadvantage: decrease in tactile
sensation
 Many authorities now recommend routine
double-gloving, which decreases the risk
of blood contact in a variety of surgical
settings.
 Selecting an inner glove one-half size
larger than usual may reduce numbness
and tightness.
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Am J Infect Control 1993;21:364-367.
Appropriate Surgical Garments
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recommendations include using
1. a reinforced gown with a plastic
urologic apron
2. water-resistant above-the-knee boots
or shoe covers,
3. a second sleeve that can be changed
when contaminated.
4. Selection: headband for sweat
Preventing Ocular, Nasal, and Facial
Exposure
Face shields are superior to goggles and
eye glasses for preventing exposure to
blood during surgical procedures.
 There is no evidence to suggest that the
aerosol route transmits HIV or other
blood-borne pathogens
 Engineering controls, including ventilation
and shielding, should be employed when
using power instruments such as bone
saws, reamers, and bovies that generate
aerosols.
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Assessing Risk Preoperatively
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Preoperative HIV testing of patients for infection-control
purposes remains controversial and most authorities do not
recommend it as a routine procedure.
It seems, however, that routine preoperative risk
assessment is a sensible approach to identifying a higher
risk subset of patients who could benefit from testing.
Identifying and labeling patients infected with HIV has not
proved effective in lowering the incidence of intraoperative
exposures, and results of at least one study indicated the
effect is not likely to be great if standard infection-control
practices are already being followed.
The price for the FDA-approved rapid HIV test kits, as
of July 2005, range from $14 to $25.
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