一名外科医生在无感染控制措施不当证据的情况下将乙肝病毒传播给多名患者。

Transmission of hepatitis B virus to multiple patients from a surgeon without evidence of inadequate infection control.

作者信息

Harpaz R, Von Seidlein L, Averhoff F M, Tormey M P, Sinha S D, Kotsopoulou K, Lambert S B, Robertson B H, Cherry J D, Shapiro C N

机构信息

Hepatitis Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

出版信息

N Engl J Med. 1996 Feb 29;334(9):549-54. doi: 10.1056/NEJM199602293340901.

DOI:10.1056/NEJM199602293340901

PMID:8569821

Abstract

BACKGROUND

Although about 1 percent of surgeons are infected with hepatitis B virus (HBV), transmission from surgeons to patients is thought to be uncommon. In July 1992, a 47-year-old woman became ill with acute hepatitis B after undergoing a thymectomy in which a thoracic-surgery resident who had had acute hepatitis B six months earlier assisted.

METHODS

To determine whether the surgeon transmitted HBV to this patient and others, we conducted chart reviews, interviews, and serologic testing of thoracic-surgery patients at the two hospitals where the surgeon worked from July 1991 to July 1992. Hepatitis B surface antigen (HBsAg) subtypes and DNA sequences from the surgeon and from infected patients were determined.

RESULTS

Of 144 susceptible patients in whose surgery the infected surgeon participated, 19 had evidence of recent HBV infection (13 percent). One of the hospitals was selected for additional study, and none of the 124 susceptible patients of the other thoracic surgeons at this hospital had evidence of recent HBV infection (relative risk, infinity; 95 percent confidence interval, 4.7 to infinity). No evidence was found for any common source of HBV other than the infected surgeon. The HBsAg subtype and the partial HBV DNA sequences from the surgeon were identical to those in the infected patients. Transmission of the infection was associated with cardiac transplantation (relative risk, 4.9; 95 percent confidence interval, 1.5 to 15.5) but not with other surgical procedures. The surgeon was positive for hepatitis B e antigen and had a high serum HBV DNA concentration (15 ng per milliliter). Our investigations identified no deficiencies in the surgeon's infection-control practices.

CONCLUSIONS

In this outbreak there was surgeon-to-patient HBV transmission despite apparent compliance with recommended infection-control practices. We could not identify any specific events that led to transmission.

摘要

背景

尽管约1%的外科医生感染了乙型肝炎病毒（HBV），但外科医生将病毒传播给患者的情况被认为并不常见。1992年7月，一名47岁的女性在接受胸腺切除术后患上了急性乙型肝炎，手术时一名6个月前曾患急性乙型肝炎的胸外科住院医生提供了协助。

方法

为了确定该外科医生是否将HBV传播给了这名患者及其他患者，我们对该外科医生在1991年7月至1992年7月工作的两家医院的胸外科患者进行了病历审查、访谈和血清学检测。确定了外科医生以及受感染患者的乙型肝炎表面抗原（HBsAg）亚型和DNA序列。

结果

在144名该感染外科医生参与手术的易感患者中，19名有近期HBV感染的证据（13%）。选择了其中一家医院进行进一步研究，该医院其他胸外科医生的124名易感患者中均无近期HBV感染的证据（相对危险度，无穷大；95%可信区间，4.7至无穷大）。除了受感染的外科医生外，未发现任何其他HBV共同来源的证据。外科医生的HBsAg亚型和部分HBV DNA序列与受感染患者的相同。感染传播与心脏移植有关（相对危险度，4.9；95%可信区间，1.5至15.5），但与其他外科手术无关。该外科医生乙型肝炎e抗原呈阳性，血清HBV DNA浓度较高（每毫升15纳克）。我们的调查未发现该外科医生在感染控制措施方面存在任何缺陷。