Biomedical Engineering and Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA.
J Environ Pathol Toxicol Oncol. 2010;29(4):293-315. doi: 10.1615/jenvironpatholtoxicoloncol.v29.i4.30.
The purpose of this report is to discuss management of operating room personnel who have had occupational exposure to blood and other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus type I (HTLV-I). HBV postexposure prophylaxis includes starting hepatitis B vaccine series in any susceptible unvaccinated operating room personnel who sustain an exposure to blood or body fluid during surgery. Postexposure prophylaxis with hepatitis B immune globulin (HBIG) is an important consideration after determining the hepatitis B antigen status of the patient. Ideally, all operating room personnel should be vaccinated with hepatitis B vaccine before they pursue their career in surgery. Immune globulin and antiviral agents (eg, interferon with or without ribavirin) should not be used for postexposure prophylaxis of operating room personnel exposed to patients with HCV; rather, follow-up HCV testing should be initiated to determine if infection develops. Postexposure prophylaxis for HIV involves a basic four-week regimen of two drugs (zidovudine and lamivudine; lamivudine and stavudine; or didanosine and stavudine) for most exposures. An expanded regimen that includes a third drug must be considered for HIV exposures that pose an increased risk for transmission. When developing a postexposure prophylaxis regimen, it is helpful to contact the National Clinicians' Postexposure Prophylaxis Hotline, (888) 448-4911. Prevention should be a major consideration in postexposure prophylaxis with the use of the double-glove hole indication system by all operating room personnel.
本报告的目的是讨论手术室人员在职业接触血液和其他可能含有乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、人类免疫缺陷病毒（HIV）和人类 T 细胞嗜淋巴细胞病毒 I 型（HTLV-I）的体液后，如何进行管理。HBV 暴露后预防包括对所有在手术过程中接触血液或体液的易感未接种疫苗的手术室人员开始接种乙型肝炎疫苗系列。在确定患者的乙型肝炎抗原状态后，乙型肝炎免疫球蛋白（HBIG）的暴露后预防是一个重要的考虑因素。理想情况下，所有手术室人员在从事手术职业之前都应接种乙型肝炎疫苗。免疫球蛋白和抗病毒药物（例如干扰素联合或不联合利巴韦林）不应用于接触 HCV 患者的手术室人员的暴露后预防；相反，应开始进行 HCV 随访检测，以确定是否发生感染。HIV 暴露后的预防包括基本的四周两药方案（齐多夫定和拉米夫定；拉米夫定和司他夫定；或去羟肌苷和司他夫定），适用于大多数暴露。对于存在增加传播风险的 HIV 暴露，必须考虑使用扩展方案，其中包括第三种药物。在制定暴露后预防方案时，联系国家临床医生暴露后预防热线（888）448-4911 会有所帮助。在使用双重手套孔指示系统时，预防应是手术室所有人员暴露后预防的主要考虑因素。
