AIDS and hepatitis B and C: contamination risk at transurethral resection. A study using sodium fluorescein as a marker.

The human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are all transmitted by minute amounts of infected blood. Surgeons are at risk of contracting these infections by a number of routes including splashes of blood on to the mucous membranes of eyes, nose and mouth, needle stick injuries and spillage of blood on chapped ungloved hands. The endoscopic surgeon is quite unaware of nearly all instances of facial contamination because the splashes are frequently both minute and dilute. Sodium fluorescein, an indelible fluorescent dye detectable in dilutions of one to two parts per million, has been used in this prospective study as a marker of irrigating fluid used during transurethral resection. In 17 out of 20 consecutive operations its presence on the face of the surgeon was revealed by photography, although only a few splashes were visible to the naked eye. There was a random distribution of splashes and also a recurring pattern of contamination of the orbit of the eye that looks through the telescope and the tip of the nose. Vaccination against hepatitis B is recommended for all endoscopic surgeons, together with the use of protective glasses and a mask that covers both the nose and mouth. The greatest danger to the health care team is from an infectious patient who is an unknown risk. It is recommended that high risk patients presenting for transurethral resection should first be screened for the presence of HBV, HCV and HIV antigens.