Viral infections relevant to surgery

Viral infections relevant to surgery

Hepatitis Both hepatitis B and hepatitis C carry risks in surgery as they are blood-borne pathogens that can be transmitted both from - the patient to the surgeon and vice versa . The usual mode of transmission is blood-to-blood contact through a needle-stick injury or a cut. Many cases of hepatitis B are asymptomatic and a surgeon may carry the virus without being aware of it. As - there is an e ff ective vaccine against hepatitis B, surgeons should know their immune status to hepatitis B and be vaccinated against it. Hepatitis C infection often becomes chronic with the risk of significant liver damage but is potentially curable with interferon-alpha and ribavirin treatment, so surgeons who are exposed to an infection risk should seek medical advice and antibody measurement. Human immunodeficiency virus The type I human immunodeficiency virus (HIV) is one of the viruses of surgical importance because it can be transmitted ). by body fluids, particularly blood. It is a retrovirus that has become increasingly prevalent through sexual transmission (both homo- and heterosexual), intravenous drug addiction and in infected blood products used to treat patients with haemophilia in particular. The risk in surgery is mostly through needle-stick injury during operations. The risk of opportunistic infections (such as Pneumocystis carinii pneumonia, tuberculosis and cytomegalovirus) and neo - plasms (such as Kaposi’s sarcoma and lymphoma) is thereby increased. In the early weeks after HIV infection, there may be a flu like illness and, during the phase of seroconversion, patients present the greatest risk of HIV transmission. It is during these early phases that drug treatment, highly active antiretro therapy (HAART), is most e ff ective through the ability of these drugs to inhibit reverse transcriptase and protease synthesis, which are the principal mechanisms through which HIV can progress. These drugs suppress the virus but do not clear it completely from the body and treated patients can still transmit the virus to others. Within 2 years, untreated HIV can progress to acquired immunodeficiency syndrome (AIDS) in 25–35% of patients. Universal precautions Patients may present to surgeons for operative treatment if they have a surgical disease and they are known to be infected or ‘at risk’, or because they need surgical intervention related to their illness for vascular access or a biopsy when they are known to have hepatitis, HIV infection or AIDS. Particular care should be taken when there is a risk of splashing/aerosol formation, particularly with power tools. Universal precautions have been drawn up by CDC in the USA and largely adopted by the NHS in the UK. In summary , these are: /uni25CF use of a full face mask ideally , or protective spectacles; /uni25CF use of fully waterproof, disposable gowns and drapes, par ticularly during seroconversion; /uni25CF boots to be worn, not clogs, to avoid injury from dropped sharps; /uni25CF double gloving needed (a larger size on the inside is more comfortable); /uni25CF allow only essential personnel in theatre; /uni25CF avoid unnecessary movement in theatre; /uni25CF respect is required for sharps, with passage in a kidney dish; /uni25CF slow meticulous operative technique is needed with mini mised bleeding. After contamination Needle-stick injuries are commonest on the non-dominant index finger during operative surgery . Hollow needle injury carries the greatest risk of viral transmission. The injured part should be washed under running water and the incident reported. Local policies dictate whether postexposure anti Data from: COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (accessed 16 August 2021). Figure 5.12 (a) (b) retroviral treatment should be given. Occupational health - advice is required after high-risk exposure, together with the need for hepatitis/HIV testing and the option for continuation in a non-operative specialty . viral COVID-19 pandemic The global pandemic of coronavirus disease 2019 (COVID - 19) was announced by the World Health Organization on 11 March 2020. As of 16 August 2021, more than 207 million cases and more than 4.36 million deaths had been reported in 210 countries. The rapid spread of the outbreak has had short-term implications f or global healthcare systems, including the field of surgery . Many hospitals were forced to stop or postpone elective surgical interventions during the first wave in early to mid-2020. However, emergency surgery and time-sensitive surgery , i.e. cancer surgery , continued with relevant precautions, including the use of personal protective equipment. COVID-19 is a contagious respiratory and vascular dis - ease. The aetiology is severe acute respiratory syndrome coro - navirus 2 (SARS-CoV-2) ( Figure 5.12a ) , which is a specific type of coronavirus. Common symptoms include fever, cough, fatigue, shortness of breath or breathing di ffi culties as well as loss of smell and taste . The incubation period may range from 1 to 14 days. While most people have mild symptoms, some - people develop acute respiratory distress syndrome (ARDS), possibly precipitated by a cytokine storm; multiorgan failure; septic shock; and hypercoagulable states. Longer term damage to organs (in particular, the lungs and heart) has been observed. Complications in postoperative surgical patients infected with COVID-19 in either an elective or emergency setting may include pneumonia ( Figure 5.12b ) , ARDS, multiorgan failure, se ptic shock and death. Measures to control COVID-19 - related morbidity and mortality have thus been implemented - by many countries, including a mandatory preopera tive cocooning of elective surgical patients 10–14 days prior to sur - gery and preopera tive COVID-19 swab testing 2–3 days prior to elective surgery . Like many other viral infections, there is no definite pharmacological cure for this infection, although there has been some evidence for supportive care, e .g. with hydroxy - chloroquine and dexamethasone. Multiple vaccines were made available at the end of 2020 and, currently , the majority - of countries have most of their population vaccinated.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Chest radiograph showing coronavirus disease 2019 (COVID-19) pneumonia changes.

Viral infections relevant to surgery

Hepatitis Both hepatitis B and hepatitis C carry risks in surgery as they are blood-borne pathogens that can be transmitted both from - the patient to the surgeon and vice versa . The usual mode of transmission is blood-to-blood contact through a needle-stick injury or a cut. Many cases of hepatitis B are asymptomatic and a surgeon may carry the virus without being aware of it. As - there is an e ff ective vaccine against hepatitis B, surgeons should know their immune status to hepatitis B and be vaccinated against it. Hepatitis C infection often becomes chronic with the risk of significant liver damage but is potentially curable with interferon-alpha and ribavirin treatment, so surgeons who are exposed to an infection risk should seek medical advice and antibody measurement. Human immunodeficiency virus The type I human immunodeficiency virus (HIV) is one of the viruses of surgical importance because it can be transmitted ). by body fluids, particularly blood. It is a retrovirus that has become increasingly prevalent through sexual transmission (both homo- and heterosexual), intravenous drug addiction and in infected blood products used to treat patients with haemophilia in particular. The risk in surgery is mostly through needle-stick injury during operations. The risk of opportunistic infections (such as Pneumocystis carinii pneumonia, tuberculosis and cytomegalovirus) and neo - plasms (such as Kaposi’s sarcoma and lymphoma) is thereby increased. In the early weeks after HIV infection, there may be a flu like illness and, during the phase of seroconversion, patients present the greatest risk of HIV transmission. It is during these early phases that drug treatment, highly active antiretro therapy (HAART), is most e ff ective through the ability of these drugs to inhibit reverse transcriptase and protease synthesis, which are the principal mechanisms through which HIV can progress. These drugs suppress the virus but do not clear it completely from the body and treated patients can still transmit the virus to others. Within 2 years, untreated HIV can progress to acquired immunodeficiency syndrome (AIDS) in 25–35% of patients. Universal precautions Patients may present to surgeons for operative treatment if they have a surgical disease and they are known to be infected or ‘at risk’, or because they need surgical intervention related to their illness for vascular access or a biopsy when they are known to have hepatitis, HIV infection or AIDS. Particular care should be taken when there is a risk of splashing/aerosol formation, particularly with power tools. Universal precautions have been drawn up by CDC in the USA and largely adopted by the NHS in the UK. In summary , these are: /uni25CF use of a full face mask ideally , or protective spectacles; /uni25CF use of fully waterproof, disposable gowns and drapes, par ticularly during seroconversion; /uni25CF boots to be worn, not clogs, to avoid injury from dropped sharps; /uni25CF double gloving needed (a larger size on the inside is more comfortable); /uni25CF allow only essential personnel in theatre; /uni25CF avoid unnecessary movement in theatre; /uni25CF respect is required for sharps, with passage in a kidney dish; /uni25CF slow meticulous operative technique is needed with mini mised bleeding. After contamination Needle-stick injuries are commonest on the non-dominant index finger during operative surgery . Hollow needle injury carries the greatest risk of viral transmission. The injured part should be washed under running water and the incident reported. Local policies dictate whether postexposure anti Data from: COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (accessed 16 August 2021). Figure 5.12 (a) (b) retroviral treatment should be given. Occupational health - advice is required after high-risk exposure, together with the need for hepatitis/HIV testing and the option for continuation in a non-operative specialty . viral COVID-19 pandemic The global pandemic of coronavirus disease 2019 (COVID - 19) was announced by the World Health Organization on 11 March 2020. As of 16 August 2021, more than 207 million cases and more than 4.36 million deaths had been reported in 210 countries. The rapid spread of the outbreak has had short-term implications f or global healthcare systems, including the field of surgery . Many hospitals were forced to stop or postpone elective surgical interventions during the first wave in early to mid-2020. However, emergency surgery and time-sensitive surgery , i.e. cancer surgery , continued with relevant precautions, including the use of personal protective equipment. COVID-19 is a contagious respiratory and vascular dis - ease. The aetiology is severe acute respiratory syndrome coro - navirus 2 (SARS-CoV-2) ( Figure 5.12a ) , which is a specific type of coronavirus. Common symptoms include fever, cough, fatigue, shortness of breath or breathing di ffi culties as well as loss of smell and taste . The incubation period may range from 1 to 14 days. While most people have mild symptoms, some - people develop acute respiratory distress syndrome (ARDS), possibly precipitated by a cytokine storm; multiorgan failure; septic shock; and hypercoagulable states. Longer term damage to organs (in particular, the lungs and heart) has been observed. Complications in postoperative surgical patients infected with COVID-19 in either an elective or emergency setting may include pneumonia ( Figure 5.12b ) , ARDS, multiorgan failure, se ptic shock and death. Measures to control COVID-19 - related morbidity and mortality have thus been implemented - by many countries, including a mandatory preopera tive cocooning of elective surgical patients 10–14 days prior to sur - gery and preopera tive COVID-19 swab testing 2–3 days prior to elective surgery . Like many other viral infections, there is no definite pharmacological cure for this infection, although there has been some evidence for supportive care, e .g. with hydroxy - chloroquine and dexamethasone. Multiple vaccines were made available at the end of 2020 and, currently , the majority - of countries have most of their population vaccinated.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Chest radiograph showing coronavirus disease 2019 (COVID-19) pneumonia changes.

Viral infections relevant to surgery

Hepatitis Both hepatitis B and hepatitis C carry risks in surgery as they are blood-borne pathogens that can be transmitted both from - the patient to the surgeon and vice versa . The usual mode of transmission is blood-to-blood contact through a needle-stick injury or a cut. Many cases of hepatitis B are asymptomatic and a surgeon may carry the virus without being aware of it. As - there is an e ff ective vaccine against hepatitis B, surgeons should know their immune status to hepatitis B and be vaccinated against it. Hepatitis C infection often becomes chronic with the risk of significant liver damage but is potentially curable with interferon-alpha and ribavirin treatment, so surgeons who are exposed to an infection risk should seek medical advice and antibody measurement. Human immunodeficiency virus The type I human immunodeficiency virus (HIV) is one of the viruses of surgical importance because it can be transmitted ). by body fluids, particularly blood. It is a retrovirus that has become increasingly prevalent through sexual transmission (both homo- and heterosexual), intravenous drug addiction and in infected blood products used to treat patients with haemophilia in particular. The risk in surgery is mostly through needle-stick injury during operations. The risk of opportunistic infections (such as Pneumocystis carinii pneumonia, tuberculosis and cytomegalovirus) and neo - plasms (such as Kaposi’s sarcoma and lymphoma) is thereby increased. In the early weeks after HIV infection, there may be a flu like illness and, during the phase of seroconversion, patients present the greatest risk of HIV transmission. It is during these early phases that drug treatment, highly active antiretro therapy (HAART), is most e ff ective through the ability of these drugs to inhibit reverse transcriptase and protease synthesis, which are the principal mechanisms through which HIV can progress. These drugs suppress the virus but do not clear it completely from the body and treated patients can still transmit the virus to others. Within 2 years, untreated HIV can progress to acquired immunodeficiency syndrome (AIDS) in 25–35% of patients. Universal precautions Patients may present to surgeons for operative treatment if they have a surgical disease and they are known to be infected or ‘at risk’, or because they need surgical intervention related to their illness for vascular access or a biopsy when they are known to have hepatitis, HIV infection or AIDS. Particular care should be taken when there is a risk of splashing/aerosol formation, particularly with power tools. Universal precautions have been drawn up by CDC in the USA and largely adopted by the NHS in the UK. In summary , these are: /uni25CF use of a full face mask ideally , or protective spectacles; /uni25CF use of fully waterproof, disposable gowns and drapes, par ticularly during seroconversion; /uni25CF boots to be worn, not clogs, to avoid injury from dropped sharps; /uni25CF double gloving needed (a larger size on the inside is more comfortable); /uni25CF allow only essential personnel in theatre; /uni25CF avoid unnecessary movement in theatre; /uni25CF respect is required for sharps, with passage in a kidney dish; /uni25CF slow meticulous operative technique is needed with mini mised bleeding. After contamination Needle-stick injuries are commonest on the non-dominant index finger during operative surgery . Hollow needle injury carries the greatest risk of viral transmission. The injured part should be washed under running water and the incident reported. Local policies dictate whether postexposure anti Data from: COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (accessed 16 August 2021). Figure 5.12 (a) (b) retroviral treatment should be given. Occupational health - advice is required after high-risk exposure, together with the need for hepatitis/HIV testing and the option for continuation in a non-operative specialty . viral COVID-19 pandemic The global pandemic of coronavirus disease 2019 (COVID - 19) was announced by the World Health Organization on 11 March 2020. As of 16 August 2021, more than 207 million cases and more than 4.36 million deaths had been reported in 210 countries. The rapid spread of the outbreak has had short-term implications f or global healthcare systems, including the field of surgery . Many hospitals were forced to stop or postpone elective surgical interventions during the first wave in early to mid-2020. However, emergency surgery and time-sensitive surgery , i.e. cancer surgery , continued with relevant precautions, including the use of personal protective equipment. COVID-19 is a contagious respiratory and vascular dis - ease. The aetiology is severe acute respiratory syndrome coro - navirus 2 (SARS-CoV-2) ( Figure 5.12a ) , which is a specific type of coronavirus. Common symptoms include fever, cough, fatigue, shortness of breath or breathing di ffi culties as well as loss of smell and taste . The incubation period may range from 1 to 14 days. While most people have mild symptoms, some - people develop acute respiratory distress syndrome (ARDS), possibly precipitated by a cytokine storm; multiorgan failure; septic shock; and hypercoagulable states. Longer term damage to organs (in particular, the lungs and heart) has been observed. Complications in postoperative surgical patients infected with COVID-19 in either an elective or emergency setting may include pneumonia ( Figure 5.12b ) , ARDS, multiorgan failure, se ptic shock and death. Measures to control COVID-19 - related morbidity and mortality have thus been implemented - by many countries, including a mandatory preopera tive cocooning of elective surgical patients 10–14 days prior to sur - gery and preopera tive COVID-19 swab testing 2–3 days prior to elective surgery . Like many other viral infections, there is no definite pharmacological cure for this infection, although there has been some evidence for supportive care, e .g. with hydroxy - chloroquine and dexamethasone. Multiple vaccines were made available at the end of 2020 and, currently , the majority - of countries have most of their population vaccinated.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Chest radiograph showing coronavirus disease 2019 (COVID-19) pneumonia changes.