Bell D M, Shapiro C N, Culver D H, Martone W J, Curran J W, Hughes J M
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia 30333.
Infect Agents Dis. 1992 Oct;1(5):263-9.
The objective was to estimate the probability of sporadic hepatitis B virus (HBV) and human immunodeficiency virus (HIV) transmission to a patient from an infected surgeon due to percutaneous injury during an invasive procedure. Risk was estimated based on a model involving three probabilities: A, the probability that the surgeon will sustain a percutaneous injury during an invasive procedure; B, the probability that the sharp object causing the injury and now contaminated with the surgeon's blood will contact the patient's wound; and C, the probability that infection would be transmitted to the patient after such an exposure. The probability of transmission during one procedure is p = A x B x C. The probability of transmission to at least one patient during N procedures is 1-(1-p)N. Values for A, B, and C were estimated from prospective studies. The estimated probability of transmission from an infected surgeon to a patient during a single procedure is 0.00024-0.0024% for HIV and 0.024-0.24% for HBV if the surgeon is positive for hepatitis B e antigen (HBeAg). The estimated probability of transmission to at least one patient during 3,500 procedures (estimated to be performed during an HIV-infected surgeon's remaining working life) is 0.81-8.1% for HIV; 57-100% for HBV if the surgeon is an HBeAg carrier. These estimates represent population averages and may not necessarily apply to a particular procedure performed by a particular surgeon, for which the risk may be considerably lower or higher than the estimated average. This risk assessment, which is based on limited data and does not take clusters of transmission into account, predicts that the risk of sporadic HBV transmission from infected surgeons to patients due to percutaneous injury during an invasive procedure is small and that the risk of HIV transmission is less than that for HBV. More data are needed to understand both sporadic and epidemic transmission in order to further reduce patient risk.
目的是评估在侵入性操作过程中，受感染外科医生因经皮损伤而将散发性乙型肝炎病毒（HBV）和人类免疫缺陷病毒（HIV）传播给患者的概率。风险是基于一个包含三个概率的模型进行估计的：A，外科医生在侵入性操作过程中发生经皮损伤的概率；B，导致损伤且现在被外科医生血液污染的锐器接触患者伤口的概率；C，在这种暴露后感染传播给患者的概率。一次操作中的传播概率为p = A×B×C。在N次操作中传播给至少一名患者的概率为1 - (1 - p)N。A、B和C的值是从前瞻性研究中估计出来的。如果外科医生乙肝e抗原（HBeAg）呈阳性，那么在单次操作中，受感染外科医生将HIV传播给患者的估计概率为0.00024 - 0.0024%，将HBV传播给患者的估计概率为0.024 - 0.24%。在3500次操作（估计在一名感染HIV的外科医生剩余工作年限内进行）中传播给至少一名患者的估计概率，对于HIV为0.81 - 8.1%；对于HBV，如果外科医生是HBeAg携带者则为57 - 100%。这些估计值代表总体平均值，不一定适用于特定外科医生进行的特定操作，对于该操作，风险可能远低于或高于估计平均值。这种基于有限数据且未考虑传播聚集情况的风险评估预测，在侵入性操作过程中，受感染外科医生因经皮损伤将散发性HBV传播给患者的风险较小，且HIV传播风险低于HBV。需要更多数据来了解散发性和流行性传播情况，以便进一步降低患者风险。
