The role of routine screening in blood-borne pathogens in Chinese patients undergoing joint arthroplasty

Objectives Surgeons face a substantial risk of infection because of the occupational exposure to blood-borne pathogens (BBPs) from patients undergoing high-risk orthopaedic procedures. This study aimed to determine the seroprevalence of four BBPs among patients undergoing joint arthroplasty in Shanghai, China. In addition, we evaluated the significance of pre-operative screening by calculating a cost-to-benefit ratio. Methods A retrospective observational study of pre-operative screening for BBPs, including hepatitis B and C viruses (HBV and HCV), human immunodeficiency virus (HIV) and Treponema pallidum (TP), was conducted for sequential patients in the orthopaedic department of a large urban teaching hospital between 01 January 2009 and 30 May 2016. Medical records were analysed to verify the seroprevalence of these BBPs among the patients stratified by age, gender, local origin, type of surgery, history of previous transfusion and marital status. Results Of the subjects who underwent arthroplasty surgery in our institution, pre-operative screening tests were available for 96.1% (11 609 patients). The seroprevalence of HBV, HCV, HIV and TP was 5.47%, 0.45%, 0.08% and 3.6%, respectively. A total of 761 seropositive cases (68.4%) were previously undiagnosed. Pre-operative screening for HIV resulted in a low cost to benefit ratio, followed by HCV and HBV. Conclusion Routine HCV and HIV screening prior to joint arthroplasty is not a cost-effective strategy. Considering the high rate of undiagnosed patients and the shortage of protective options, targeted pre-operative screening for HBV and syphilis should be considered for the protection of healthcare workers in China who have not been vaccinated. Cite this article: Bone Joint Res 2017;6:566–571.

[1]  A. Schulz,et al.  In-vitro evaluation of surgical helmet systems for protecting surgeons from droplets generated during orthopaedic procedures. , 2016, The Journal of hospital infection.

[2]  C. Krettek,et al.  Is there a benefit for health care workers in testing HIV, HCV and HBV in routine before elective arthroplasty? , 2016, Orthopaedics & traumatology, surgery & research : OTSR.

[3]  Xu Wang,et al.  Epidemiology of Hepatitis B and Hepatitis C Infections and Benefits of Programs for Hepatitis Prevention in Northeastern China: A Cross-Sectional Study. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  Michael A Mont,et al.  The Impact of Hepatitis C on Short-Term Outcomes of Total Joint Arthroplasty. , 2015, The Journal of bone and joint surgery. American volume.

[5]  S. So,et al.  Cost-Effectiveness and Cost Thresholds of Generic and Brand Drugs in a National Chronic Hepatitis B Treatment Program in China , 2015, PloS one.

[6]  D. Horwitz,et al.  Percutaneous and Mucocutaneous Exposure Among Orthopaedic Surgeons: Immediate Management and Compliance With CDC Protocol , 2015, Journal of orthopaedic trauma.

[7]  Zhenglun Liang,et al.  Strategy vaccination against Hepatitis B in China , 2015, Human vaccines & immunotherapeutics.

[8]  D. Kothari,et al.  Hepatitis B immunization in healthcare workers , 2015, Annals of gastroenterology.

[9]  Babak Otoukesh,et al.  Prevalence of Hepatitis B virus, Hepatitis C virus and human immunodeficiency virus infections among patients candidate for orthopedic trauma surgeries , 2015, Medical journal of the Islamic Republic of Iran.

[10]  Man-li Tong,et al.  Characterization of the classical biological false-positive reaction in the serological test for syphilis in the modern era. , 2014, International immunopharmacology.

[11]  E. Delsole,et al.  Risk of hepatitis C virus exposure in orthopedic surgery: is universal screening needed? , 2014, American journal of orthopedics.

[12]  K. Thursky,et al.  Are they protected? Immunity to vaccine‐preventable diseases in healthcare workers at an Australian hospital , 2014, Australian and New Zealand journal of public health.

[13]  Ling Lu,et al.  The Current Hepatitis C Virus Prevalence in China May Have Resulted Mainly from an Officially Encouraged Plasma Campaign in the 1990s: a Coalescence Inference with Genetic Sequences , 2013, Journal of Virology.

[14]  K. Reilly,et al.  Prevalence of HIV and Syphilis Infection among High School and College Student MSM in China: A Systematic Review and Meta-Analysis , 2013, PloS one.

[15]  S. Takemoto,et al.  Comorbidities and perioperative complications in HIV-positive patients undergoing primary total hip and knee arthroplasty. , 2013, The Journal of bone and joint surgery. American volume.

[16]  J. Bogner,et al.  Is there a benefit to a routine preoperative screening of infectivity for HIV, hepatitis B and C virus before elective orthopaedic operations? , 2013, Infection.

[17]  N. Giori,et al.  Prevalence of hepatitis C virus infection in the veteran population undergoing total joint arthroplasty. , 2012, The Journal of arthroplasty.

[18]  A. Nardone,et al.  HIV testing in community settings in resource‐rich countries: a systematic review of the evidence , 2012, HIV medicine.

[19]  V. K. Singh,et al.  Splash in elective primary knee and hip replacement: are we adequately protected? , 2009, The Journal of bone and joint surgery. British volume.

[20]  Li Li,et al.  Evaluation of the impact of hepatitis B vaccination among children born during 1992-2005 in China. , 2009, The Journal of infectious diseases.

[21]  I. Mackie,et al.  The risks of splash injury when using power tools during orthopaedic surgery: a prospective study. , 2008, Acta orthopaedica Belgica.

[22]  C. Ranaboldo,et al.  Blood and body fluid splashes during surgery--the need for eye protection and masks. , 2007, Annals of the Royal College of Surgeons of England.

[23]  Muhammad Shoaib Khan,et al.  Prevalence of hepatitis 'B' and 'C' in orthopaedics patients at Ayub Teaching Hospital Abbottabad. , 2007, Journal of Ayub Medical College, Abbottabad : JAMC.

[24]  Changsu Han,et al.  Mental Health of Healthcare Workers who Experience Needlestick and Sharps Injuries , 2006, Journal of occupational health.

[25]  S. Singh,et al.  Risk of conjunctival contamination in total joint arthroplasty. , 2006, The Journal of hospital infection.

[26]  H. Tillmann,et al.  Low Prevalence of Chronic Hepatitis C, but High Prevalence of Elevated Aminotransferases in a Cohort of 2026 Patients Referred for Orthopaedic Surgery in the Eastern Part of Germany , 2006, Zeitschrift fur Gastroenterologie.

[27]  P. Finn,et al.  Glove perforation and contamination in primary total hip arthroplasty. , 2005, The Journal of bone and joint surgery. British volume.

[28]  L. Eralp,et al.  A correction of windswept deformity by fixator assisted nailing. A report of two cases. , 2004, The Journal of bone and joint surgery. British volume.

[29]  K. Wong,et al.  Transmission and prevention of occupational infections in orthopaedic surgeons. , 2004, The Journal of bone and joint surgery. American volume.

[30]  S. Hutchinson,et al.  Risk of hepatitis C virus transmission from patients to surgeons: model based on an unlinked anonymous study of hepatitis C virus prevalence in hospital patients in Glasgow , 2003, Gut.

[31]  P. Persiani,et al.  Prevalence of hepatitis B and hepatitis C in an orthopaedics and traumatology ward. , 2001, La Chirurgia degli organi di movimento.

[32]  J. Masson,et al.  Risk of transmission of blood-borne viral infection in orthopaedic and trauma surgery. , 2000, The Journal of bone and joint surgery. British volume.

[33]  J. Mineiro,et al.  [The risk of seroconversion in surgeons of the hepatitis B, hepatitis C and human immunodeficiency viruses (in a specific surgical population)]. , 1997, Acta medica portuguesa.

[34]  G. Xia,et al.  Prevalence of hepatitis B and C virus infections in the general Chinese population. Results from a nationwide cross-sectional seroepidemiologic study of hepatitis A, B, C, D, and E virus infections in China, 1992 , 1996 .

[35]  T. Trumble,et al.  Incidence of hepatitis C in patients requiring orthopaedic surgery. , 1995, The Journal of bone and joint surgery. British volume.

[36]  A. Tait,et al.  Prevention of Occupational Transmission of Human Immunodeficiency Virus and Hepatitis B Virus Among Anesthesiologists: A Survey of Anesthesiology Practice , 1994, Anesthesia and analgesia.

[37]  J. Wright,et al.  Human immunodeficiency virus transmission between surgeons and patients in orthopaedic surgery. , 1993, Clinical orthopaedics and related research.

[38]  A. Utkan,et al.  [Seroprevalences of hepatitis B, hepatitis C, and HIV in patients admitted to orthopedic and traumatology department]. , 2006, Acta orthopaedica et traumatologica turcica.