Mandelbrot D A, Smythe W R, Norman S A, Martin S C, Arnold R M, Talbot G H, Stolley P D
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia.
Surg Gynecol Obstet. 1990 Aug;171(2):99-106.
Policy makers face a conflict between satisfying concerns of health care workers (HCW) about the occupational risk of human immunodeficiency virus (HIV) infection and ensuring adequate care for patients. This conflict is particularly severe in the field of surgery. We mailed a questionnaire on the surgical care of patients infected with HIV to 1,461 surgeons in New York City and Philadelphia, and 551 (37.7 per cent) responded. Although 1.9 per cent currently were testing all patients for HIV, 42.6 per cent of surgeons believed that all patients in their hospital should be tested. Of the surgeons who responded, 6.3 per cent refused to treat any patient infected with HIV. Less than 50 per cent recommended the use of barrier precautions on all patients in their hospital. Surgeons in New York City were significantly more likely than those in Philadelphia to favor separate facilities for HIV-infected patients. Surgeons considering themselves at higher occupational risk were more likely than those at lower risk to favor widespread testing, separate facilities and use of precautions. Surgeons reported a wide range of opinions. Their approach to the use of barrier precautions differs from the Centers for Disease Control recommendations. The patterns observed suggest that distinct policies may be appropriate for different hospitals.
政策制定者在满足医护人员对感染人类免疫缺陷病毒（HIV）职业风险的担忧与确保为患者提供充分护理之间面临冲突。这种冲突在外科领域尤为严重。我们向纽约市和费城的1461名外科医生邮寄了一份关于HIV感染患者外科护理的问卷，551人（37.7%）回复。虽然目前有1.9%的人对所有患者进行HIV检测，但42.6%的外科医生认为他们医院的所有患者都应接受检测。在回复的外科医生中，6.3%拒绝治疗任何HIV感染患者。不到50%的人建议对他们医院的所有患者使用屏障防护措施。纽约市的外科医生比费城的外科医生更倾向于为HIV感染患者设立单独的设施。认为自己职业风险较高的外科医生比风险较低的外科医生更倾向于广泛检测、单独设施和使用防护措施。外科医生报告了广泛的意见。他们使用屏障防护措施的方法与疾病控制中心的建议不同。观察到的模式表明，不同的医院可能需要不同的政策。
