Blood-borne Pathogens and the Orthopaedic Surgeon

Lynda Loucks, BMR PT, MSc
Physiotherapist and Researcher
Concordia Hip and Knee Institute
Winnipeg, MB

Eric Bohm, M.D., FRCSC
Chair, COA National Standards Committee
Winnipeg, MB

Tracy Wilson, MSc, M.D., FRCSC
Member, COA National Standards Committee
Thunder Bay, ON


Patient safety is of concern to health care providers (HCP) and health professional regulating bodies. There are risks inherent to the delivery of health care for both the patient and the provider. The risk of transmission of blood-borne pathogens (BBP) such as human immunodeficiency virus (HIV) or hepatitis B or C (HBV or HCV) is an example of these risks. There is a trend nationally and internationally for regulatory bodies to implement policy affecting the reporting, scope of practice and care of physicians infected with BBP. In Canada these policies vary by province in their formality and extent. Recently, the Canadian Orthopaedic Association's National Standards Committee developed a Position Statement on BBP based upon the latest scientific evidence. The COA felt this topic was worthy of its attention given the recent regulatory changes in Ontario, and the fact that this issue does impact all members of the orthopaedic community.


BBP_Fig_1Contact with blood and body materials in orthopaedic surgery can place orthopaedic surgeons at relatively high risk of exposure to HIV, HBV and HCV. Although transmission of any of these viruses can theoretically occur from either patient to provider or from provider to patient, the risk of transmission from patients to surgeon is obviously the greatest, considering the nature of the activities being performed, the rate of exposure to blood and body materials, and the variety of medical conditions in patients undergoing treatment. Conversely, the risk of transmission of infection from HCP to patient is extremely low. With the advent of greater awareness of the risks of transmission, the stringent application of universal precautions with every patient, immunization of HCPs and changes in disease prevalence cases of transmission of BBP from HCP to patients have not been documented in Canada since the mid 1990's. Even in cases where health care providers with BBP have provided surgical care to large numbers of patients, there are exceedingly few cases confirmed "to patient" transmission and subsequent seroconversion when proper preventive techniques were used.

Ultimately, the best prevention against transmission of BBP is to use a range of infection control methods including equipment, medical and pharmacological strategies. To protect one's livelihood and ability to contribute to the field of medicine, the addition of some form of income protection insurance is also an important consideration.

The process of developing a position statement involved searching existing literature, web sites, regulatory and government documents and disability insurance coverage in the area of BBP, reviewing relevant articles and summarizing related literature. Through this process, two position statements were found having similarity to that envisioned by the COA. The National Standards Committee felt that the position statement by the Canadian Association of Paediatric Surgeons was reflective of the current evidence and human resource policies. Therefore, their statement was used with permission to form the framework of the COA statement. To supplement this research, the COA undertook a survey of its members to assess the current state of knowledge and practice with respect to prevention of transmission of BBP. The results of this survey can be viewed on the COA web site in the Member Services > Health Policy section. Resulting from this work was a full report summarizing the findings of the literature review, a position statement and advice for members.