Transmission of hepatitis B with resultant restriction of surgical practice
L. A. Lettau, J. D. Smith, D. Williams, W. D. Lundquist, F. Cruz, R. K. Sikes and S. C. Hadler
Five patients developed acute hepatitis B (HB) within four months after
major operations by the same obstetric-gynecologic surgeon. Investigation
documented that the surgeon was HB surface antigen and HB e antigen
positive; all five patients had an HB subtype matching that of the surgeon
and no other identifiable risk factors for HB viral infection. A
seroprevalence study comparing exposed surgical and obstetric patients with
a control group showed no significant additional subclinical HB
transmission. The surgeon resumed his surgical practice but was required to
obtain written informed consent from patients, to double-glove, and to
employ appropriate surgical techniques to avoid self-injury. Seven months
later, acute HB occurred in a patient two months after a cesarean section,
resulting in exclusion of the surgeon from major operations. This is the
fifth outbreak of nosocomial HB linked to an obstetric-gynecologic surgeon,
and it reinforces the need for health care workers to receive preexposure
prophylaxis with HB vaccine to prevent such occurrences.
