Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 630
  • Home
  • Print this page
  • Email this page


 
   Table of Contents      
COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 3  |  Page : 339-340

Commentary on: Practice pattern of cataract surgeons when operating on seropositive patients


Department of Cornea, Cataract and Refractive, Centre for Sight Hospital, Safdarjung Enclave, New Delhi, India

Date of Web Publication18-Feb-2019

Correspondence Address:
Dr. Rashmi Deshmukh
Department of Cornea, Cataract and Refractive, Centre for Sight Hospital, B5/24, Safdarjung Enclave, Opposite Deer Park, New Delhi - 110 029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_46_19

Rights and Permissions

How to cite this article:
Sachdev M, Deshmukh R. Commentary on: Practice pattern of cataract surgeons when operating on seropositive patients. Indian J Ophthalmol 2019;67:339-40

How to cite this URL:
Sachdev M, Deshmukh R. Commentary on: Practice pattern of cataract surgeons when operating on seropositive patients. Indian J Ophthalmol [serial online] 2019 [cited 2019 May 24];67:339-40. Available from: http://www.ijo.in/text.asp?2019/67/3/339/252423



Occupational blood exposure leading to the spread of blood-borne viral infections (BBVIs) is emerging as a matter of concern among health care workers (HCWs) in the recent years. Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) form the majority of BBVIs reported among HCWs. According to WHO, HBV is more efficiently transmitted than HIV. This is because patients affected with HBV have a higher viral load in their blood, as opposed to HIV-positive individuals who have a lower viral load.[1] The risk of transmission is higher in HBV (30%) as compared to HIV (0.3%).[2] When it comes to the risk of seroconversion, the risk is higher for HBV (3.5%) and HCV (1.7%) as compared to HIV (0.3%).[3],[4]

Among medical professionals, ophthalmologists are at highest risk of sharp injuries.[5] Blood splash and needlestick injuries (NSI) are the common causes of transmission of BBVIs among ophthalmologists and paramedical personnel.[6]

Centers for Disease Control and Prevention have given Universal precautions to minimize the risk of exposure to infected blood and transmission of BBVIs. It mainly emphasizes on prevention of contact with infected blood by using barrier methods, such as impervious gowns, gloves, goggles, and masks. Although preoperative screening reduces the risk of BBVIs, routine screening before cataract surgery does not include screening for HIV, HBV, and HCV. This increases the risk of BBVIs from undiagnosed seropositive patients among HCWs.

Since phacoemulsification is a small incision surgery, and most of the times the incision is made clear corneal, the risk of bleeding in these patients is negligible. Nevertheless, there is a likelihood of bleeding from limbal vessels and; in case of scleral incisions, episcleral, and scleral vessels are likely to bleed minimally. The major risk of transmission of BBVIs is through NSI where the barrier to blood contact is lost.

The prevalence of HBV, HCV, and HIV in adults in India is 2.4–15.9%, 1.2%, and 0.36%, respectively. The debate about the relative merits and demerits of universal screening versus universal precautions remains unresolved. In our practice, we screen all the patients for HBV, HCV, and HIV preoperatively. The decision to perform the surgery under topical anesthesia or peribulbar block is taken depending on the type of cataract. We prefer using a disposable kit and a seropositive case is usually posted as the last case of the day. Use of double gloves, impervious gowns, and masks is recommended to reduce the risk of BBVIs. We never refuse a seropositive patient for surgery. However, we owe it to ourselves, our HCWs and our patients, to ensure that optimal precautions are taken while handling seropositive patients.



 
  References Top

1.
Hepatitis B Fact sheet no 204. Geneva, World Health Organisation; 2000.  Back to cited text no. 1
    
2.
Mashud I, Khan H, Khattak AM. Relative frequency of hepatitis B and C viruses in patients with hepatic cirrhosis at DHQ teaching hospital D.I. Khan. J Ayub Med Coll Abottabad 2004;16:32-4.  Back to cited text no. 2
    
3.
Klein RS. Universal precautions for preventing occupational exposures to human immunodeficiency virus type 1. Am J Med 1991;90:141-4.  Back to cited text no. 3
    
4.
Lee JH, Cho J, Kim YJ, Im SH, Jang ES, Kim JW, et al. Occupational blood exposures in health care workers: Incidence, characteristics, and transmission of bloodborne pathogens in South Korea. BMC Public Health 2017;17:827.  Back to cited text no. 4
    
5.
Mansour AM. Which physicians are at high risk for needlestick injuries. Am J Infect Control 1990;18:208-10.  Back to cited text no. 5
    
6.
Honavar SG. Universal screening versus universal precautions in ophthalmic surgery. Indian J Ophthalmol 2018;66:355-6.  Back to cited text no. 6
[PUBMED]  [Full text]  




 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed344    
    Printed1    
    Emailed0    
    PDF Downloaded66    
    Comments [Add]    

Recommend this journal