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March 4, 1988, Vol 259, No. 9 >
ARTICLE | March 4, 1988

Routine Preoperative Screening for HIV: Title and subTitle BreakDoes the Risk to the Surgeon Outweigh the Risk to the Patient? FREE

Michael D. Hagen, MD; Klemens B. Meyer, MD; Stephen G. Pauker, MD
[+] Author Affiliations

Reprint requests to the Division of Clinical Decision Making, Department of Medicine, New England Medical Center and Tufts University School of Medicine, 750 Washington St, Boston, MA 02111 (Dr Pauker).


JAMA. 1988;259(9):1357-1359. doi:10.1001/jama.1988.03720090047033
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References

EVEN among our society's leaders, the growing epidemic of human immunodeficiency virus (HIV) infection has produced panic. A presidential candidate (New York Times, June 7, 1987, section 4, p 1) and a US senator (Wall Street J, June 18,1987, p 33) have suggested that we quarantine people who are infected. School boards have barred seropositive children from the classroom; ministers have excluded them from church.1 A clergyman has proposed that police officers should be authorized to shoot anyone suspected of being infected if that person threatens to bite them (USA Today, Aug 14,1987, p 3A). Some of our colleagues would refuse to provide care to infected patients.2 None of these responses are either reasonable or humane. To criticize them, however, is not enough. We also must examine critically our profession's reactions to the crisis. As physicians, we must be logical in our responses and responsible in our leadership.

REFERENCES

1 +
Gianelli DM:  MD regrets HIV test for boys. Am Med News , (Setp 25) , 1987;, pp 1, 18.
2 +
Richardson JL, Lochner T, McGuigan K, et al:  Physician attitudes and experience regarding the care of patients with acquired immunodeficiency syndrome (AIDS) and related disorders (ARC). Med Care 1987;;25:675-685.
3 +
Breo D:  Dr. Koop calls for AIDS tests before surgery. Am Med News , (June 26) , 1987;, pp 1, 17-21.
4 +
Board of Trustees:  Prevention and control of acquired immunodeficiency syndrome: An interim report. JAMA 1987;;258:2097-2103.
5 +
Confronting AIDS: Directions for Public Health, Health Care and Research . Washington, DC, National Academy Press, 1986;, pp 17, 37-83, 97-98,120-130,310.
6 +
Bayer R, Levine C, Wolf SM:  HIV antibody screening: An ethical framework for evaluating proposed programs. JAMA 1986;;256:1768-1774.
7 +
Meyer KB, Pauker SG:  Screening for HIV: Can we afford the false positive rate? N Engl J Med 1987;;317:238-241.
8 +
Cockerill FR, Edson RS, Chase RC, et al: 'False positive' antibodies to human immunodeficiency virus (HIV) detected by an enzyme-linked immunosorbent assay (ELISA) in patients at low risk for acquired immunodeficiency syndrome (AIDS). Presented at the Third International Conference on AIDS, Washington, DC, June 1,1987.
9 +
Weiss SH, Saxinger WC, Rechtman D, et al:  HTLV-III infection among health care workers: Association with needle-stick injuries. JAMA 1985;;254:2089-2093.
10 +
 Update: Human immunodeficiency virus infections in health-care workers exposed to blood of infected patients. MMWR 1987;;36:285-289.
11 +
McCormick RD, Maki DG:  Epidemiology of needle-stick injuries in hospital personnel. Am J Med 1981;;70:928-932.
12 +
Cruse PJE, Foord R:  The epidemiology of wound infection. Surg Clin North Am 1980;;60:27-40.
13 +
Furuhashi M, Miyamae T:  Effect of pre-operative hand scrubbing and influence of pinholes appearing in surgical rubber gloves during operation. Bull Tokyo Med Dent Univ 1979;;26:73-80.
14 +
Snydman DR, Bryan JA, Hanson B:  Hemodialysis-associated hepatitis in the United States— 1972. J Infect Dis 1975;;132:109-113.
15 +
West DJ:  The risk of hepatitis B infection among health professionals in the United States: A review. Am J Med Sci 1984;;287:26-33.
16 +
Pantelick EL, Steere AC, Lewis HD, et al:  Hepatitis B infection in hospital personnel during an eight-year period: Policies for screening and pregnancy in high risk areas. Am J Med 1981;;70:924-927.
17 +
Levy BS, Harris JC, Smith JL, et al:  Hepatitis B in ward and clinical laboratory employees of a general hospital. Am J Epidemiol 1977;;106:330-335.
18 +
Osterholm M, Andrews JS:  Viral hepatitis in hospital personnel in Minnesota: Report of a statewide survey. Minn Med 1979;;62:683-689.
19 +
Polesky HF, Hanson M:  AABB-CAP survey data on hepatitis—incidence, surveillance and prevention. Am J Clin Pathol 1980;;74:565-568.
20 +
Denes AE, Smith JL, Maynard JE, et al:  Hepatitis B infection in physicians: Results of a nationwide seropidemiologic survey. JAMA 1978;;239: 210-212.
21 +
Reynolds RA: Socioeconomic Characteristics of Medical Practice: 1985 . Chicago, American Medical Association, 1985;, pp 80-81.
22 +
Dienstag DL, Ryan DM:  Occupational exposure to hepatitis B virus in hospital personnel: Infection or immunization? Am J Epidemiol 1982;;115:26-39.
23 +
Feinman SV, Krassnitzky O, Sinclair JC, et al:  Prevalence and significance of hepatitis B surface antigen in a general hospital. Can Med Assoc J 1975;;112:43-45.
24 +
Mahoney JP, Richman AV, Teague PO:  Admission screening for hepatitis B surface antigen in a university hospital. South Med J 1978;;71:624-628.
25 +
Linnemann CC, Hegg ME, Ramundo N, et al:  Screening hospital patients for hepatitis B surface antigen. Am J Clin Pathol 1977;;67:257-259.
26 +
Hirsch MS, Wormser GP, Schooley RT, et al:  Risk of nosocomial infection with human T-cell lymphotropic virus III (HTLV III). N Engl J Med 1985;;312:1-4.
27 +
Henderson DK, Saah AJ, Zak BJ, et al:  Risk of nosocomial infection with human T-cell lymphotropic virus type III/lymphadenopathy-associated virus in a large cohort of intensively exposed health care workers. Ann Intern Med 1986;;104:644-647.
28 +
McCray E:  Occupational risk of the acquired immunodeficiency syndrome among health care workers. N Engl J Med 1986;;314:1127-1132.
29 +
Geberding JL, Bryant-LeBlanc CE, Nelson K, et al:  Risk of transmitting the human immunodeficiency virus, cytomegalovirus, and the hepatitis B virus to health care workers exposed to patients with AIDS and AIDS-related conditions. J Infect Dis 1987;;156:1-8.
30 +
Staver S:  Orthopod urges HIV testing. Am Med News , (Dec4) , 1987;, pp 1, 36-37.
31 +
Padian N, Wiley J, Winkelstein W: Male to female transmission of human immunodeficiency virus: Current results, infectivity rates, and San Francisco population seroprevalence estimates. Presented at the Third International Conference on AIDS, Washington, DC, June 4,1987.
32 +
Voeller B, Potts M:  Has the condom any proved value in preventing the transmission of sexually transmitted viral disease—for example, acquired immune deficiency syndrome? Br Med J 1985;; 291:1196.
33 +
Conant M, Hardy D, Sernatinger J, et al:  Condoms prevent transmission of AIDS-associated retrovirus. JAMA 1986;;255:1706.
34 +
 Human T-lymphotropic virus type III/lymphadeonopathy-associated virus antibody prevalence in U.S. military recruit applicants. MMWR 1986;;35:421-423.
35 +
Handsfield HH, Cummings MJ, Swenson PD:  Prevalence of antibody to human immunodeficiency virus and hepatitis B surface antigen in blood samples submitted to a hospital laboratory: Implications for handling specimens. JAMA 1987;;258: 3395-3397.
36 +
Hearings Before the Subcommitte on Regulation and Business Opportunities of the House Committee on Small Business, 100th Cong, 1st sess (1987) (testimony of Donald S. Burke, MD).
37 +
Hearings Before the Subcommittee on Regulation and Business Opportunities of the House Committee on Small Business, 100th Cong, 1st sess (1987) (testimony of Lawrence H. Miike, MD, JD).
38 +
Cleary PD, Barry MJ, Mayer KH, et al:  Compulsory premarital screening for the human immunodeficiency virus: Technical and public health considerations. JAMA 1987;;258:1757-1762.
39 +
Barnes DM:  New questions about AIDS test accuracy. Science 1987;;238:884-885.
40 +
Lynch P, Jackson MM, Cummings MJ, et al:  Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med 1987;;107:243-246.
41 +
 Recommendations for prevention of HIV transmission in health-care settings, LEADS FROM THE MMWR. JAMA 1987;;258:1293, 1299-1300,1305.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Gianelli DM:  MD regrets HIV test for boys. Am Med News , (Setp 25) , 1987;, pp 1, 18.
2 +
Richardson JL, Lochner T, McGuigan K, et al:  Physician attitudes and experience regarding the care of patients with acquired immunodeficiency syndrome (AIDS) and related disorders (ARC). Med Care 1987;;25:675-685.
3 +
Breo D:  Dr. Koop calls for AIDS tests before surgery. Am Med News , (June 26) , 1987;, pp 1, 17-21.
4 +
Board of Trustees:  Prevention and control of acquired immunodeficiency syndrome: An interim report. JAMA 1987;;258:2097-2103.
5 +
Confronting AIDS: Directions for Public Health, Health Care and Research . Washington, DC, National Academy Press, 1986;, pp 17, 37-83, 97-98,120-130,310.
6 +
Bayer R, Levine C, Wolf SM:  HIV antibody screening: An ethical framework for evaluating proposed programs. JAMA 1986;;256:1768-1774.
7 +
Meyer KB, Pauker SG:  Screening for HIV: Can we afford the false positive rate? N Engl J Med 1987;;317:238-241.
8 +
Cockerill FR, Edson RS, Chase RC, et al: 'False positive' antibodies to human immunodeficiency virus (HIV) detected by an enzyme-linked immunosorbent assay (ELISA) in patients at low risk for acquired immunodeficiency syndrome (AIDS). Presented at the Third International Conference on AIDS, Washington, DC, June 1,1987.
9 +
Weiss SH, Saxinger WC, Rechtman D, et al:  HTLV-III infection among health care workers: Association with needle-stick injuries. JAMA 1985;;254:2089-2093.
10 +
 Update: Human immunodeficiency virus infections in health-care workers exposed to blood of infected patients. MMWR 1987;;36:285-289.
11 +
McCormick RD, Maki DG:  Epidemiology of needle-stick injuries in hospital personnel. Am J Med 1981;;70:928-932.
12 +
Cruse PJE, Foord R:  The epidemiology of wound infection. Surg Clin North Am 1980;;60:27-40.
13 +
Furuhashi M, Miyamae T:  Effect of pre-operative hand scrubbing and influence of pinholes appearing in surgical rubber gloves during operation. Bull Tokyo Med Dent Univ 1979;;26:73-80.
14 +
Snydman DR, Bryan JA, Hanson B:  Hemodialysis-associated hepatitis in the United States— 1972. J Infect Dis 1975;;132:109-113.
15 +
West DJ:  The risk of hepatitis B infection among health professionals in the United States: A review. Am J Med Sci 1984;;287:26-33.
16 +
Pantelick EL, Steere AC, Lewis HD, et al:  Hepatitis B infection in hospital personnel during an eight-year period: Policies for screening and pregnancy in high risk areas. Am J Med 1981;;70:924-927.
17 +
Levy BS, Harris JC, Smith JL, et al:  Hepatitis B in ward and clinical laboratory employees of a general hospital. Am J Epidemiol 1977;;106:330-335.
18 +
Osterholm M, Andrews JS:  Viral hepatitis in hospital personnel in Minnesota: Report of a statewide survey. Minn Med 1979;;62:683-689.
19 +
Polesky HF, Hanson M:  AABB-CAP survey data on hepatitis—incidence, surveillance and prevention. Am J Clin Pathol 1980;;74:565-568.
20 +
Denes AE, Smith JL, Maynard JE, et al:  Hepatitis B infection in physicians: Results of a nationwide seropidemiologic survey. JAMA 1978;;239: 210-212.
21 +
Reynolds RA: Socioeconomic Characteristics of Medical Practice: 1985 . Chicago, American Medical Association, 1985;, pp 80-81.
22 +
Dienstag DL, Ryan DM:  Occupational exposure to hepatitis B virus in hospital personnel: Infection or immunization? Am J Epidemiol 1982;;115:26-39.
23 +
Feinman SV, Krassnitzky O, Sinclair JC, et al:  Prevalence and significance of hepatitis B surface antigen in a general hospital. Can Med Assoc J 1975;;112:43-45.
24 +
Mahoney JP, Richman AV, Teague PO:  Admission screening for hepatitis B surface antigen in a university hospital. South Med J 1978;;71:624-628.
25 +
Linnemann CC, Hegg ME, Ramundo N, et al:  Screening hospital patients for hepatitis B surface antigen. Am J Clin Pathol 1977;;67:257-259.
26 +
Hirsch MS, Wormser GP, Schooley RT, et al:  Risk of nosocomial infection with human T-cell lymphotropic virus III (HTLV III). N Engl J Med 1985;;312:1-4.
27 +
Henderson DK, Saah AJ, Zak BJ, et al:  Risk of nosocomial infection with human T-cell lymphotropic virus type III/lymphadenopathy-associated virus in a large cohort of intensively exposed health care workers. Ann Intern Med 1986;;104:644-647.
28 +
McCray E:  Occupational risk of the acquired immunodeficiency syndrome among health care workers. N Engl J Med 1986;;314:1127-1132.
29 +
Geberding JL, Bryant-LeBlanc CE, Nelson K, et al:  Risk of transmitting the human immunodeficiency virus, cytomegalovirus, and the hepatitis B virus to health care workers exposed to patients with AIDS and AIDS-related conditions. J Infect Dis 1987;;156:1-8.
30 +
Staver S:  Orthopod urges HIV testing. Am Med News , (Dec4) , 1987;, pp 1, 36-37.
31 +
Padian N, Wiley J, Winkelstein W: Male to female transmission of human immunodeficiency virus: Current results, infectivity rates, and San Francisco population seroprevalence estimates. Presented at the Third International Conference on AIDS, Washington, DC, June 4,1987.
32 +
Voeller B, Potts M:  Has the condom any proved value in preventing the transmission of sexually transmitted viral disease—for example, acquired immune deficiency syndrome? Br Med J 1985;; 291:1196.
33 +
Conant M, Hardy D, Sernatinger J, et al:  Condoms prevent transmission of AIDS-associated retrovirus. JAMA 1986;;255:1706.
34 +
 Human T-lymphotropic virus type III/lymphadeonopathy-associated virus antibody prevalence in U.S. military recruit applicants. MMWR 1986;;35:421-423.
35 +
Handsfield HH, Cummings MJ, Swenson PD:  Prevalence of antibody to human immunodeficiency virus and hepatitis B surface antigen in blood samples submitted to a hospital laboratory: Implications for handling specimens. JAMA 1987;;258: 3395-3397.
36 +
Hearings Before the Subcommitte on Regulation and Business Opportunities of the House Committee on Small Business, 100th Cong, 1st sess (1987) (testimony of Donald S. Burke, MD).
37 +
Hearings Before the Subcommittee on Regulation and Business Opportunities of the House Committee on Small Business, 100th Cong, 1st sess (1987) (testimony of Lawrence H. Miike, MD, JD).
38 +
Cleary PD, Barry MJ, Mayer KH, et al:  Compulsory premarital screening for the human immunodeficiency virus: Technical and public health considerations. JAMA 1987;;258:1757-1762.
39 +
Barnes DM:  New questions about AIDS test accuracy. Science 1987;;238:884-885.
40 +
Lynch P, Jackson MM, Cummings MJ, et al:  Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med 1987;;107:243-246.
41 +
 Recommendations for prevention of HIV transmission in health-care settings, LEADS FROM THE MMWR. JAMA 1987;;258:1293, 1299-1300,1305.

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