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  • Title: A prospective study on the risk of exposure to HIV during surgery in Zambia.
    Author: Consten EC, van Lanschot JJ, Henny PC, Tinnemans JG, van der Meer JT.
    Journal: AIDS; 1995 Jun; 9(6):585-8. PubMed ID: 7662197.
    Abstract:
    OBJECTIVE: To investigate the relative risk of occupational HIV transmission for surgeons practising in tropical Africa compared with their western colleagues. DESIGN AND SETTING: From June to November 1993, a prospective study was performed at St Francis' Hospital, Katete, Zambia (350-bed hospital which serves a community of 300,000 people). METHODS: The HIV seroprevalence among consecutive surgical patients and the incidence of occupational parenteral exposures to blood during surgery were prospectively studied in a Zambian district hospital. HIV seroprevalence was determined by taking blood from the surgical patients on admission into the operating theatre. Serum was stored at -20 degrees C and transported to the Academic Medical Centre of the University of Amsterdam, where the presence of HIV antibodies was tested by enzyme immunoassay and seropositive samples confirmed by Western blot. Number of parenteral exposures during the study period was scored by interviewing the seven surgeons and their personnel after each surgical procedure about accidental parenteral exposures to blood. The total number of parenteral exposures per surgeon per year was obtained by extrapolation. The cumulated risk of seroconversion due to parenteral blood exposure can be calculated as: 1-(1-fp)ny, where f is the population seroprevalence, p the chance of transmission per incident (estimated to be 0.46%), n the number of parenteral exposures per year and y the years of practice. RESULTS: HIV seroprevalence in the surgical patient group was 22.3%. Twelve parenteral exposures to blood (surgeons, n = 8; other personnel, n = 4) took place in 1161 operations. Number of parenteral exposures per surgeon was extrapolated to three per year. The non-dominant index finger was exposed in 10 out of the 12 parenteral exposures. Based on these data, the risk of contracting HIV infection for a surgeon practising in Zambia for 5 years is 1.5%. The risk for a surgeon working in a western hospital when f = 0.23%, n = 20 per year (5.6% of 350 operations) and y = 5 is estimated at 0.1%. CONCLUSIONS: Although occupational exposure rate was relatively low, the HIV seroprevalence was so high that the relative cumulated seroconversion risk for surgeons in tropical Africa is estimated to be 15 times higher than in western countries. This implies that health-care organizations should bear in mind that each year one out of 300 employees working in tropical Africa may become occupationally infected with HIV. A prospective study conducted in 1993 at St Francis' Hospital in Katete, Zambia, indicated that the human immunodeficiency virus (HIV) seroconversion risk among surgeons in tropical Africa may be 15 times higher that in developed countries. During the six-month study period, surgeons recorded any parenteral blood exposure and serum samples from 296 patients randomly selected from the 1078 patients undergoing surgery in this period were analyzed; of these, 66 (22.3%) were HIV-positive. During the 1161 surgical procedures, there were 12 (1%) superficial parenteral exposures, four of which were found to involve HIV-infected blood. These exposures included 10 needle-sticks with a non-hollow suture needle, one hand laceration, and one splash to the eye. Half involved obstetricians/gynecologists. For a surgeon working in Zambia for five years, the risk of contracting HIV through parenteral exposure can--on the basis of this study--be calculated at 1.5% given a 22.3% patient seroprevalence rate and an average of three exposures per year (0.7% of 400 operations per year per surgeon). For a western surgeon, this risk is 0.1% (0.23% seroprevalence rate and 20 accidental injuries per year--5.6% of 350 operations). The lower number of parenteral exposures among Zambian surgeons reflects the lack of power tools in the tropics and the relative simplicity of surgical procedures. On the basis of these findings, it can be estimated that one in every 300 surgical employees in tropical Africa will become occupationally infected with HIV, and the risk of exposure can be expected to increase along with increases in HIV seroprevalence.
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