Human immunodeficiency virus testing and the risk to the surgeon of acquiring HIV

Physicians and other health care workers risk infection with human immunodeficiency virus (HIV), hepatitis B virus and other infectious agents. Most authorities have argued against routine testing of patients preoperatively for HIV infection because it would not prevent or reduce the risk of infection to health care workers. They agree with the policy of the Centers for Disease Control that advocates universal precautions for all patients. Surgeons have not been reassured by these arguments. They claim that their exposure to blood during operation exposes them to increased risk of infection. The risk of acquiring HIV from a single needle-stick injury is low. However, most surgeons are interested in their lifetime risk of infection. In this study, a mathematical model for predicting the risk of acquiring HIV in patients in a given hospital and the total number of needle-stick injuries are given. Using minimal likely HIV seroprevalence, this model predicts that at least 47 of the approximately 18,000 Fellows of the American College of Surgeons would become infected. New data showing early treatment can lead to increased longevity in infected patients with HIV, the fact that many health care workers do not follow universal precautions and other arguments are put forward to support a suggested routine--voluntary testing of all surgical patients for antibody to HIV.