BACKGROUND: Blood-borne pathogens, most notably HIV, hepatitis B (HepB) virus, and hepatitis C (HepC) virus, constitute significant occupational hazard to the reconstructive surgeon. This study is the first to examine the prevalence of blood-borne pathogen infections (BPIs) in a facial trauma reconstruction practice.
METHODS: We studied 10,592 consecutive trauma patients presenting to an urban, level I trauma center (January 2005 to December 2015) with facial fractures, based on International Statistical Classification of Disease, 9th Edition, coding. Data collected included HIV, HepB, and HepC test results before or at index admission, type of operation, age, sex, and history of intravenous drug use.
RESULTS: At the trauma admission, 328 patients (3.1%) had a diagnosed BPIs: HIV positive (n = 85; 33.3%), chronic HepC (n = 140; 54.9%), chronic HepB (n = 28; 11.0%), or coinfection with HIV and HepC (n = 29; 11.4%). The prevalence of BPI by age was normally distributed, with HIV prevalence reaching a peak in the fifth decade of life (2.6%), and chronic HepC or HepB prevalence reaching a peak in the sixth decade of life (4.0%, 0.8%, respectively). BPI was more likely in African Americans (odds ratio [OR], 1.5; P = 0.004), in those who sustain injury from assault (OR, 2.2; P < 0.001) and in comorbid substance use or psychiatric disorders (notably, intravenous drug abuse OR, 10.7; P < 0.001). The different facial fractures treated operatively had a similar prevalence of BPI (P = 0.135); however, operative mandible fractures were the fractures most associated with chronic HepC infections (3.9%).
CONCLUSION: The prevalence of BPI in the urban, facial fracture population may be higher than that of the general population (3.1% versus 2.0%). The increased risk to surgical staff and the benefit of early diagnosis could justify routine screening for BPI in high-risk patients (ie, assault injuries, history of smoking, intravenous drug abuse, and psychiatric comorbidity).