Hepatitis%20in%20a%20surgeon-%20%20%20problem%20oriented%20learning:%20Part%20II

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Hepatitis in a surgeon- problem oriented
learning Part II

• Paul Froom MD, MOccH
• Chief of Epidemiology
• Israel- National Institute of Occupational and
  Environmental Health
• Associate Professor of Epidemiology
• Sackler School of Medicine, Tel Aviv University

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Primary purpose of the lecture

• Learn about the risk and prevention of infectious
  diseases (HIV, HBV, HCV) in health care workers
  and in their patients
• Learn the following terms infectivity,
  virulence, pathogenicity, host,
  reservoir,carrier, common source, propagated
  disease, colonization, epidemics,

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Surgeon with HIV

• 3 per 1000 infectivity
• Nearly universally fatal
• Seroconversion within 3 months
• Cumulative risk to surgeons 1 low risk areas,
  10 high risk areas
• identified exposure treat with antiviral drugs
• decreased transmission rate- 79

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Surgeon with hepatitis C

• NO vaccine
• 2,000 cases of HCV in HCWs reported annually in
  the USA
• Prevalence- 0.5-18 in hospitalized patients
• infectivity 0-10
• Chronic liver disease, cancer of the liver

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Ideal Hospital program

• Vaccination of all HCWs for HBV
• Periodic lectures on the risk of infection-
  required
• Double gloving, check gloves after surgery for
  perforations
• Check hands of surgeon for injury

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Ideal Hospital program (2)

• Procedures for drawing and distributing blood
• Visors for surgery provided
• Injured HCWs- patients checked for HIV, HBV and
  HCV
• If exposed to HBV give booster dose of vaccine
  and hepatitis B immune globulin

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Ideal Hospital program (3)

• Exposure to HIV three drugs given
• Sexual partners of the HBV infected HCW should be
  vaccinated

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Other terms Host (1)

• person or animal who lodges the infectious agent
• E.g. the surgeon is the host for hepatitis B if
  he passes on the disease to his patients.

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Reservoir (2)

• Any place, person, animal, arthropod, plant, soil
  or substance or combination of these in which an
  infectious agent normally lives and multiplies or
  survives.
• E.g. Our surgeon and other humans are the
  reservoir for hepatitis B infection.

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Carrier (3)

• Person or animal who is well, yet harbors the
  infectious agent and serves as a potential source
  of infection
• The surgeon is a carrier if his liver biopsy is
  normal
• definition of well??

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Colonization (4)

• Multiplication of infectious agents in the body
  of man or animal.
• Includes both symptomatic and asymptomatic
  infections
• Our surgeon is colonized with hepatitis B.

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Epidemic transmission

• Epidemic is the occurrence of a cohort of cases
  of an illness which is clearly in excess of
  normal expectancy.
• Gynecological surgeon who infected 9 of his
  patients is an epidemic
• Common source single source for infection most
  common food poisoning.

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Epidemic transmission (2)

• Propagated disease disease from multiple sources
• E.g. Surgeon infected his patients who infected
  their family members, etc.
• Herd immunity Protection of all members of the
  group from spread of the infectious agent if
  nearly all are immunized.