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

Correspondence

Protection of a Surgeon From Dangerous Needlesticks

Alexander A. Fokin, MD, PhD, Francis Robicsek, MD, PhD, Thomas N. Masters, PhD, Chad R. Swan, MD

Department of Thoracic and Cardiovascular Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, USA

alexander.fokin{at}carolinashealthcare.org

To the Editor:

The article by Trachiotis and colleagues [1] and the related discussion wisely call attention to the ever-present risk of human immunodeficiency virus seroconversion in health care personnel after accidental injuries from contaminated instruments. We have also examined this known danger and proposed practical recommendations [2–4]. Our questions of interest were these: how fast does the infection spread from the site of inoculation, and what may be done immediately if the accident occurs despite all precautions?

Our experimental findings indicated that after subcutaneous introduction (the depth at which needle sticks usually occur), it takes the simulated viruses about 6 minutes to appear in major lymph channels but less than a third of this to enter the main blood circulation. The lymph, however, will carry 103 times more viral-sized particles, but with much less speed than blood [5]. We also found that about 90% of the inoculum remained in loco for a prolonged period with slow release into the circulation, thus justifying local treatment. While tourniquet application increased this time period, active movements and massage promoted dissemination [4]. The existence of extensive communications between lymph and blood pathways at the peripheral level may provide flow in both directions, with prevailing conveyance from lymph to blood. This explains the rapid dissemination, regardless of the site of initial entry [6]. It was also established that, in the feline model, seroconversion after needle stick could be prevented by immediate infiltration of the site with an antiviral solution (Betadine). We found that the more extensive the injury (eg, knife cut), the less effective the treatment [2].

Immediate tourniquet application above the injury site and rapid local infiltration with a virucidal agent (which should be already available in a syringe) may slow dissemination, decrease the amount of the spreading virus, and increase the effectiveness of systemic treatment [3, 4]. Local treatment should be a supplement to systemic treatment, which should be started immediately.

References

  1. Trachiotis GD, Alexander EP, Benator D, Gharagozloo F. Cardiac surgery in patients infected with the human immunodeficiency virus. Ann Thorac Surg. 2003;76:1114–1118[Abstract/Free Full Text]
  2. Robicsek F, Duncan GD, Black JW, Masters TN, Robicsek SA, Rice HE. Prevention of retrovirus infection after injury with contaminated instruments: an experimental study. Ann Thorac Surg. 1991;52:74–77[Abstract]
  3. Robicsek F, Fokin AA, Masters TN, Cook JW. Inhibition of needlestick-induced simulated viremia by local measures. Ann Thorac Surg. 2000;70:229–233[Abstract/Free Full Text]
  4. Fokin AA, Robicsek F, Masters TN. Accidental injuries by HIV-contaminated instruments in health provider or research environments: can seroconversion be prevented? Am Surg. 2000;66:14–21[Medline]
  5. Fokin AA, Robicsek F, Masters TN, Schmid-Schönbein, Jenkins S. Propagation of viral-size particles in lymph and blood after subcutaneous inoculation. Microcirculation 2000;7:193–200
  6. Fokin AA, Robicsek F, Masters TN. Transport of viral-size particulate matter after intravenous versus intralymphatic entry. Microcirculation. 2000;7:357–365[Medline]




This Article
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Chad R. Swan
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