When we talk about blood-borne infections we mean hepatitis and HIV where the concern is that
patients carrying these viruses are asymptomatic and unaware that they are carriers. The relevance
to me as an anaesthetist is protecting my staff. We practice what is called universal precautions
which means effectively we treat patients as if they have every dangerous virus known to man and
we make sure that any body fluids are treated with the utmost care so there is no risk of passing any
infection to a health care worker or indeed another patient or relative.

However occasionally we get what we call needlestick injuries where a nurse or doctor is cut or
pricked with an instrument or needle that has been used on a patient. I think our policy when this
happens in the UK has been very poor so I was interested to attend a recent update lecture on HIV

The development of the group of drugs called retrovirals has revolutionised the treatment of HIV.
People who have been infected with the aids virus can expect to live a normal life if they take
retrovirals. I was fascinated to learn that taking retrovirals also effectively prevents you passing the
virus to anybody else. Several recent studies have shown that sexual partners are quite safe and in
the UK surgeons are now allowed to operate provided they are properly treated and monitored

Despite this 4600 patients die a year in the UK from aids because they do not know that they have
been infected. The commonest group are the silver surfers – people in their 50s and 60s who have
been in a stable relationship and have divorced or been widowed and subsequently had new sexual
partners. They have missed the worry of getting HIV from a new partner and have unprotected sex.
Prof Anderson pointed out that if 90% of people were tested, 90% of those were infected picked up
and 90% of those were treated the epidemic would disappear. In the UK we treat 90% of those
known to be infected and testing is certainly 90% effective but we are not testing enough people. By
comparison in the US more people are tested but few people can afford the drugs

So the message needs to go out to get tested. Having AIDS is not a death sentence and taking
retrovirals gives you a normal quality and length of life.

So now to the anaesthetic issues! The good news is that if, when a health care worker has a
needlestick injury we can check whether the patient has HIV, we can start retrovirals immediately
and even prevent the healthcare worker from getting the disease in the first place. Equally with
hepatitis early treatment can prevent liver damage and death. We can also offer treatment to the
unsuspecting patient. The issue we are faced with however is identifying whether the patient is a
carrier so the person who has been inoculated faces often weeks of worry and concern. In the UK we
can only test a patient after a needlestick injury with their permission.

So as well as advising all my patients to be tested for their own benefit I would ask anybody who is
told that there was a needlestick injury during their operation to agree to having their blood tested.