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Ann Thorac Surg 2004;78:1882-1883
© 2004 The Society of Thoracic Surgeons

Correspondence

Reply

Gregory Trachiotis, MD, E. Pendleton Alexander, MD

George Washington University Medical Center, 50 Irving St, Washington, DC 20422, USA

gtrachiotis{at}mfa.gwu.edu

To the Editor:

The letter by Fokin and colleagues regarding needle sticks raises a very important issue in health care. Percutaneous injury, usually through a hollow-bore needle, remains the most common mode of occupational human immunodeficiency virus (HIV) transmission. In cardiovascular and thoracic surgery, needle stick injury is by far the most prevalent. The Center for Disease Control estimates more than 380,000 needle-stick injuries occur in US hospitals each year, yet the proportion occurring with HIV-infected patients remains largely unknown. Pooled data from prospective studies suggest the average risk of HIV transmission after percutaneous exposure to HIV-infected blood to be 0.03% and 0.09% after mucous membrane exposure.

As the authors point out, once exposure has occurred, it is important to immediately clean the wound (our preference is with alcohol), and then go to occupational health, notify infectious disease, and perform HIV testing on the patient and the injured. The results of rapid HIV assessment can be known within hours with current testing. Our preference is prophylactic/empiric treatment with antiretroviral therapy, but each institution should have guidelines. For any health hazard, and especially needle sticks from high-risk patients, prevention and planning is the key. As we have discussed, a HIV-infected patient should optimally be on highly active antiretroviral therapy (HAART), have low viral loads, and CD4 counts greater than 200. Additionally, although the risk potential for HIV transmission is a concern, the high association of coinfection (as high as 40% to 60%) with hepatitis C is perhaps more problematic. Preventing injury remains the single best therapy, and operating teams should plan and take preventive measures with these patients, as the numbers of these patients will continue to increase and present a challenge for years to come.





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