Cost is always a concern in the present health care delivery, even in developed countries. The prevalence of such disease is quite low (in most of the area of the world). In such scenario, doing these tests in all patients costs billion. Is this cost-effective? if it should be done mandatorily, why? Or, should these tests be done based on history and examination?
It should be tested to preventing infecting the medical staff as well as the instrument and the future patients too
Think the same as Adam.
Should be done.
But we also should use history snd risk factors if it is not covered by the regulator in your country.
We are not permorfing these tests as a routine before surgery unless there is some evidence based on patient history however I think ,based in a recent case that patient himself told me that he was HIV positive ,that these test should be performed as a routine laboratory evaluation for staff protection and also for patient protection and even patient treatment
As per the standard precaution That needs to be followed in health care practice, using PPE (personal protection equipment) is mandatory in surgery and is followed. The reusable instruments used in the surgery are always autoclaved before using in next surgery. Moreover knowing a positive case doesn't always lead to use complete disposable materials which though desirable is not possible in economic point of view in most of the countries. So, doesn't it question the routine use of these tests. I fully agree that if the patient has high risk behaviour or risk factors for such diseases, we should do the test. The it is no more a routine but indicated test.
Ideally, testing for HIV, HBsAg and HCV should be mandatory for elective surgeries in particular, especially in areas where the diseases are prevalent. Like some have commented above, it may not be cost-effective to do them routinely before surgery in most countires especially in Low and Medium Income countries. Unlike in Russia as Konstatin observed, the tests are done routinely before elective surgery. For now the best option would be by indication following history of risky behaviour/exposure etc and ofcourse suspicion from clinical examination.
Dear colleague,
I think in endemic countries it should be interesting to screen HIV, HBsAg and anti-HCV before surgery.
Best regard.
Yes, Nouhoum, but this requires resources which endemic countries may not be able to afford. It will make an interesting research to screen all patients in endemic areas before surgery if there will be funding for such research. The findings will likely inform further decisions in the matter.
In last eight years, I have worked in three tertiary care teaching hospitals situated in three different zones of India and in all the hospital the tests are invariably done. Cost is born by patients mostly. The prevalence if such positive cases are very less except in few known pocket and tribe / area. So, I feel the tests better be done in those endemic area, groups and in patients with risks or history suggestive. Otherwise, the cost appears to be very high for a country like India or other developing or third world countries.
No. Patient BBV status is immaterial if universal precautions are in place
In Kosovo, the prevalence of viral hepatitis B and C is very high.
Thus, is mandatory preoperative detection of HBV or HCV. We have more caese with posthepatitis hepatic cirrhosis and its complications
Different from viral hepatitis, HIV is with very low prevalence, and there cases is in control.
my opinion is: testing for HIV, HBsAg and anti-HCV should be mandatory before surgery and not only for the patients but also (periodically, say every six months) for the surgical team.
As much as I agree that infection can be prevented by applying Universal Precautionary measures, the "if" factor still remains pertinent. For instance,
not all health facilities offering surgery especially in rural areas in resource-poor countries can afford to provide/use universal precaution.Again, even when universal precaution is in place, some health workers' may not use it [attitudinal] but if they know the patient is positive for HIV/HBsAg/HCV, they will most likely apply universal precaution before surgery.
Precautionary measures like using PPE (gloves, plastic gown, shoes/sandal, mask, cap except protecting eye glasses) are usually used in India in all the cases. No instruments are reused without sterilization. It is also not that instruments used in a positive case(be HIV, Hep B or C) is not always disposable (affordability is an issue) and are reused after sterilization. But I have also seen a practice of covering operating tables and to some extent floor with plastics (with an idea to contain body fluids) in our country (India). And it is also seen that commercial disposable kits for PPE are used in such cases which actually nothing extra but having a mask with plastic to shield the eyes from splash and goggles. So, if all the measures are already used (except coving the table and floor with plastics) even in non-positive cases, I hardly find a reason to screen each and every patient preoperatively routinely. Rather the tests can be done based on the endemic data, risk factors and clinical parameters.
No, all patients should be considered as infectious. as there is a window period during which the patient is more infectious inspite of testing negative.
This is true as a general rule. But, window or non window, the majority of those infected test positive. And there is an enormous reservoir of chronically infected patients. Let's priviledge practice on gramatics.
IT is not onlly or cross infecting the patinets tha the tests are routinely done.
It should be borne in mind that if the health care worker(HCW) contacts the disease, 'AT WORK"a whole can of worms is opened up for the employer.
The insurance and compensation for the health care worker is a big issue because that HCW will find it impossible to be employed gainfully. Occupational exposures like needle prick injuries and the like are investigated appropriately to identify the HCW who may show signs of infection in future. Such employees can claim compensaton for lack of gainful employment .
Sir, a negetive test doesn't mean that patient doesn't have a infection or virus in body as in window period. Likewise a test positive case doesn't mean that needle prick injury will not happen. Every case is taken , in fact should be taken as positive case and precautions and PPE should be used. Prick mostly happen in hand/fingers and those are always covered by gloves be it positive or negative case.
I quite agree with habib that every case should be taken as possible and all precautionary measure put in place for every surgery, especially where these tests are not done routinely.
I am agree with sunil lialin all patients should be considered as infectious, therefor it is not mandatory
The treatment depends on the possible aetiology and the abck ground of the patient.
Two additional points which should be considered are -
# Electrolyte imbalance needs to be checked at the very outset.
# postoperative AF is a different ball game-the aim is RHYTHM CONTROL and -anticoagulation.
It is not mandatory at all. Only in selected and suspected cases and of course in transplants surgeries
It is not considered mandatory here to test for each of the infections,but of course in many cases this information is available.
We do though increasingly tend to treat all patients as potential infection hazards,and I do think that such caution is very sensible.
We need not only to protect ourselves,but also as has been alluded to above,to protect our patients.
There have been an appreciable number of cases of patients infected by staff who have these or other conditions,and regular staff checks may not be far away.
In short,treat everyone the same way,and with the same caution.
It council must be recommended in special geographical areas and for very risk patients, but clearly it can´t be generalized this opinion
Dear it should be mandatory before surgery to be sure that any future infection on the patient is not from the surgery process that it could be there before the surgery.
Abstract
Background and Objectives: Currently, there is no recommendation or guideline on routine preoperative viral serology testing. This online questionnaire-based survey was conducted to explore the current practice and opinion across the country (India). Methodology: After obtaining permission from the investigators' affiliated institute, a set of 12 questions with multiple choices was sent to the anesthesiologists, surgeons, and public health professionals using the Google Form. The participants anonymously completed this online-based questionnaire. The responses were downloaded in the Excel format and further expressed in absolute number and percentage scale. Interprofessional comparisons were made using Fisher's exact test (INSTAT software from GraphPad Prism Software Inc., La Jolla, CA, USA), and P < 0.05 was considered statistically significant. Results: A total of 1157 e-mails were sent, of which 216 bounced; 22.8% of the remaining responded, the majority (76.3%) were anesthesiologists. One-hundred and eighty-seven (89.9%) responders opined for routine preoperative viral testing: 182 (87.5%) were practicing, while 142 out of the 206 (68.9%) of the responders' hospitals had a protocol in place. Compared to the opinions of public health administrators/community physicians, no statistically significant difference (all P > 0.05) was found between the anesthesiologists and the surgeons. Even the anesthesiologists, as well as the surgeons, had similar opinions and practices (all P > 0.05) except the anesthesiologists who were having statistically significantly higher knowledge about the inability to detect cases by serology testing during the window period (P = 0.02). Conclusion: Preoperative viral (hepatitis B virus surface antigen, anti-hepatitis C virus, and human immunodeficiency virus I and II) testing is very rampant as routine, and nine out of ten practitioners opine for the mandatory routine practice in India.
From: https://dx.doi.org/10.4103/ami.ami_38_19
http://www.actamedicainternational.com/text.asp?2020/7/1/31/286421
May be interesting in some patients in epidemic areas and in difficult cases
I agree with Luis Rodrigo that in epidemic areas and in patients based on clinical judgment preoperative viral serology tests are needed as in the present time with COVID-19
I also agree that it should be done in epidemic area routinely and as per clinical suspicion in other areas... However, the routine preoperative order in even non-epidemic area is very common...
In epidemic areas and in patients based on clinical judgment (for ex patients with liver tumors) preoperative viral serology tests are needed as in the present time with COVID-19
- Badges
- Science method