RISKS TO THE ANESTHESIOLOGIST
Several potential risks to the anesthesiologist are related to
the provision of care (see Chapter
88
), including the medicolegal risk, the risk of an allergic reaction,
and the risk of a needlestick injury and transmission of disease from the patient
to the practitioner. The medicolegal risks are described in Chapter
89
.
It is becoming increasing apparent that anesthesiologists are
at risk for latex allergy, which can lead to a life-threatening reaction. Many anesthesiologists
realize that they are sensitized to latex and apply appropriate precautions. The
problem is that many sensitized individuals are asymptomatic. Brown and coworkers
[203]
studied 168 eligible anesthesiologists and
nurse anesthetists working in the anesthesia department of The Johns Hopkins Hospital.
The prevalence of latex allergy with clinical symptoms was 2.4% and that of latex
sensitization without clinical symptoms was 10.1%. The prevalence of irritant or
contact dermatitis was 24%. These data suggest that latex is an important problem
to the anesthesiologist and that there is a need to transform the hospital to a latex-free
environment.
There has always been concern that anesthesiologists are at risk
for contracting a disease from a patient. In the past, the risk was primarily hepatitis,
but the human immunodeficiency virus (HIV) is a greater concern today. In a review
of the literature, Berry and Greene[204]
reported
that at least 20 different pathogens have been transmitted through accidental needlestick
injuries.
Among anesthesia personnel in several studies conducted in the
United States, hepatitis B seropositivity ranged from 12.7% to 48.6%, a rate at least
four times greater than that in the general population.[205]
[206]
[207]
The
risk of hepatitis B infection after a percutaneous exposure to antigen-positive blood
is estimated to be 27% to 43%.[208]
The development
of the hepatitis B vaccine has substantially reduced this risk. Hepatitis C virus
has been identified as a major cause of post-transfusion hepatitis. There have been
several reports of occupationally acquired hepatitis in health care workers.[209]
Because up to 50% of infected individuals develop signs of chronic liver infection,
this represents a potentially serious problem.
Among the greatest fears of the health care worker is HIV infection.
The risk of acquiring HIV is approximately 0.4% from a single percutaneous exposure
to blood or bloody fluid from an HIV-infected patient.[210]
There has been at least one case report of an anesthesiologist who was infected
with HIV from a needlestick injury during insertion of a central venous catheter
into an HIV-positive patient.[211]
Several strategies have been developed to reduce the transmission
of communicable diseases (see Chapter
88
). Although anesthesiologists traditionally think of the risk to the
patient, they must now include the risk to themselves. The widespread adoption of
universal precautions should reduce the rate of infection; however, anesthesiologists
have not accepted these recommendations widely. In a study of nine hospitals, 59%
of the contaminated percutaneous injuries were preventable.[212]
In a theoretical model of risk of HIV infection, it was estimated that the 30-year
occupational risk was 0.10% to 0.22% in low-prevalence areas and 8.26% to 13% in
high-prevalence areas.[213]
The researchers suggested
that double-gloving practices may lead to reduced risk.
