Should surgeons with Hepatitis B Virus (HBV) be banned from performing surgery?

From the Guidelines

Surgeons with Hepatitis B Virus (HBV) should not be categorically banned from performing surgery, but their practice should be managed based on their viral load and adherence to safety protocols. According to the most recent and highest quality study, HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields 1. Surgeons with HBV who have high viral loads (typically above 200 IU/mL) may need to have their practice restricted for certain exposure-prone procedures where there is risk of injury to the surgeon that could expose the patient to the surgeon's blood. However, surgeons with low viral loads or those on effective antiviral therapy such as entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide can generally continue practicing safely. These medications typically reduce viral loads to undetectable levels, minimizing transmission risk. Some key points to consider include:

• Regular monitoring of viral loads every 3-6 months is essential for infected surgeons.
• Standard precautions including double-gloving during procedures, proper handling of sharps, and immediate reporting of any potential exposure incidents should be strictly followed.
• The approach balances patient safety with the surgeon's right to practice, recognizing that HBV transmission from healthcare workers to patients is extremely rare when proper precautions are taken and viral loads are controlled 1. The evidence suggests that with proper management and precautions, surgeons with HBV can practice safely without posing a significant risk to patients 1.

From the Research

Transmission of HBV from Surgeons to Patients

• The transmission of Hepatitis B Virus (HBV) from surgeons to patients is a significant concern, as evidenced by several studies 2, 3, 4, 5, 6.
• A study published in 2002 found that a surgeon with HBV transmitted the virus to 8 patients during high-risk and low-risk surgical procedures over a period of 4 years 2.
• Another study published in 1990 reported that 7 surgeons had definitely and 4 possibly been infected with HBV by a patient while operating, highlighting the risk of transmission from patients to surgeons 3.
• The risk of transmission from surgeons to patients is influenced by factors such as the surgeon's viral load, the type of procedure, and the use of precautions 4, 5, 6.

Risk Factors for Transmission

• The duration of the operation and the occurrence of complications during or after surgery have been identified as independent risk factors for transmission of HBV from surgeons to patients 2.
• The viral load of the surgeon is also a significant factor, with highly viremic HBV carriers with HBeAg transmitting the virus to an average of 4% of their patients during high-risk procedures 4.
• Even surgeons without detectable HBeAg can transmit HBV to patients, as demonstrated by a study published in 1997 6.

Prevention and Control Measures

• Prevention of HBV transmission from surgeons to patients requires a stringent strategy for vaccination and testing of surgeons, as well as optimization of infectious disease surveillance 2, 4.
• Current recommendations include vaccination of medical staff against HBV with control of immunity, regular examinations of staff for HCV, and restrictions on exposure-prone procedures for infected staff with high viral loads 4.
• The use of precautions, such as eye protection and safe handling of needles, is also crucial in preventing transmission of HBV from patients to surgeons 3.