Page 271 - AIDSBK23C

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than 1 hour. The greatest number of needle sticks occur on the surgeon's non-dominant hand,
indicating that injuries could be significantly reduced if maneuvers such as palpation of a suture
needle and use of a retractor rather than fingers to hold tissues were avoided.[1072,1085,1086]
There have been no documented cases of accidental transmission of HIV to a patient during
surgery.[1087]
Adherence to universal precautions requires an ongoing effort on the part of all
personnel. Ironically, lack of compliance is most acute in situations where risk of exposure is
greatest--in emergency situations with profuse bleeding. The most common factors cited for lack
of adherence in use of protective equipment include: insufficient time to put on protective
equipment, interference with skillful maneuvers by protective equipment, and uncomfortable feel
of protective equipment. The first excuse requires a reordering of priorities and a need to keep
protective materials close at hand. The second and third excuses can be approached in training.
Persons who begin their careers with proper training and routinely employ protective equipment
are unlikely to encounter difficulties with use of such equipment.[1072,1088]
The major risk factor for the HIV-infected patient for operative morbidity and mortality
is the extent of immunosuppression. The risk is increased when the CD4 count is below
200/microliter and/or the HIV-1 viral load is >10,000 copies/mL. Complications from surgery in
persons without this extent of immunosuppression in HIV infection are similar to the general
population.[1089] HIV positive patients undergoing abdominal surgery with a lower CD4
lymphocyte count CD4 counts are more likely to require an urgent operation and experience a
complication with increased mortality from the surgery.[1090]