Based on look-back studies, the transmission rate of HCV from infected surgeons to their operated patients was 0.26% in the United Kingdom and 0.13% in Germany [6
]. In Norway, a cardiac surgeon transmitted HCV during open heart surgery to 3.7% (n
10) of operated patients [12
]. Should surgeons be screened for HCV to protect their patients against iatrogenic infection? To define appropriate preventive measures, the prevalence of HCV among medical personnel must be known. This survey was undertaken in order to estimate the prevalence of HCV among transmission-prone medical personnel.
The screening of anonymous samples of 729 persons who perform EPPs at the Academic Medical Center in Amsterdam revealed only one HCV infected health care worker (0.14%, 95% CI: <0.01% to 0.85%). After the sampling of Amsterdam citizens, Baaten et al. calculated a similar overall prevalence of HCV infection in Amsterdam of 0.62% (95% CI: 0.1–1.1%). The large majority of the HCV-positive citizens in the sampling concerned immigrants with risk factors such as intravenous drug abuse and blood transfusion before 1991 [13
The low prevalence of HCV among EPP-performing health care workers in Amsterdam is reassuring, considering that the large majority of the personnel was over 30 years of age, representing significant occupational exposure to blood in the past. Failure to detect HCV infection in the archived samples, due to deterioration during prolonged storage, seems unlikely. In addition, our results are in line with the early findings of Beltrami et al., who reviewed seroprevalence studies among hospital-based personnel in the 1990s, and also found HCV seroprevalence rates comparable to or lower than in the general population in several Western countries [14
]. More recently, Marconi et al. found no HCV infection following 390 Italian health care workers from 1999 to 2009 [15
Unrelated to this anonymous study, two physicians at the AMC acquired HCV infection after a needlestick injury, respectively, in 2000 [16
] and in 2009. At first sight, these incidents seem inconsistent with the low prevalence of HCV infection as reported in this study. However, in both incidents, the physician was aware of HCV infection in the patient. Apparently, effective self-referral took place. Obviously, both infections occurred after the sampling for anti-HBs testing of the surgeons took place. This illustrates that our study does not provide a cumulative measurement of all HCV transmissions to EPP-performing personnel at the AMC up till now; it provides a cross-sectional overview of the HCV status of 729 workers, with careers covering nearly 10,000 person-years of occupational exposure to blood at the time of sampling. Nevertheless, it cannot be ruled out that increased exposure to HCV occurred after the sampling of the personnel for this study took place, which would cause an underestimation of the prevalence of HCV in this report.
Among Amsterdam citizens, HCV infection can be attributed to risk factors such as intravenous drug abuse, blood transfusion before 1991 and unprotected sex between HIV-infected men [13
]. HCV infection among local surgeons can be attributed to occupational exposure to the blood of HCV-infected patients or to personal non-occupational risk behaviour. From an occupational health care perspective, HCV infection among hospital-based personnel can be an occupational disease for which simple screening and rapidly improving antiviral therapy is available [18
]. The recurrent screening of personnel for HCV may reveal HCV infections caused by unreported needlestick injuries and non-occupational sources. However, in this study, only one of 729 health care workers was found to be HCV-infected. Against this background, for the protection of personnel and patients, the follow-up of physicians after occupational exposures may be sufficient, without recurrent screening of personnel for HCV infection. Recurrent screening is less productive if the incidence of HCV is low and a careful follow-up of occupational exposures takes place, but it is superior to the follow-up of reported needlestick injuries if a zero-risk approach is desirable and costs are less relevant.