Spinal surgery for HIV-infected patients: Experience in Taichung Veterans General Hospital

1. 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

4. The HIV/AIDS Epidemic From 行政院愛滋病防治推動委員會 2006/06/02

5. Risk of transmission from patient to healthcare workers

6. 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 abscess2. R/O C5-6 spinal tumor 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 Patient

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8. PRE-OP POST-OP

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10. Risk After Occupational Exposure • 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.

11. Intraoperative Exposure • 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.

12. 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. Am J Infect Control 1993;21:364-367. • Selecting an inner glove one-half size larger than usual may reduce numbness and tightness.

13. Appropriate Surgical Garments • 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

14. 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.

15. Assessing Risk Preoperatively • 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.

16. The price for the FDA-approved rapid HIV test kits, as of July 2005, range from $14 to $25.

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