General Medical Information

Occupational Transmission Of Disease

James A. Duncavage
John R. Coleman, Jr.

In the otolaryngology clinic, the risk of transmission of disease exists both from the physician to the patient and from the patient to the physician. Close contact with patients, the numerous body fluids physicians encounter, and the increasing need for outpatient/clinic-based invasive procedures have increased the risk of disease transmission to the physician and to patient. Furthermore, it is estimated that up to 70% of human immunodeficiency virus (HIV)-infected persons will consult an otolaryngologist for head and neck symptoms; often this encounter occurs before the diagnosis of acquired immunodeficiency syndrome has been made. Moreover, the HIV virus has been cultured from tears, middle ear effusions, and saliva; antibodies to the virus have been isolated in cerumen, tears, middle ear effusions, and saliva.

Despite widespread knowledge of these precautions, health care workers do not always follow these recommendations closely. One recent study reported that 46 residents and 4 medical students were observed as they performed 128 invasive procedures in a tertiary care children’s hospital. Universal precaution guidelines were followed correctly only 54% of the time. Several similar studies have reached the same conclusion, underscoring the need for more effective educational programs.

We must make deliberate attempts to improve the use of universal precautions not only because of the fear of sanctions but also to protect ourselves and our patients. Each office must have an “exposure control plan” that outlines and documents health care workers’ training in and knowledge of universal precautions and prevention of disease transfer. Each otolaryngologist should wear gloves for all examinations in which contact with a body fluid will occur. Protective eyewear should be worn for all invasive procedures and other instances when splashes and sprays of infective materials may be encountered (i.e., endoscopy). The physician should consider wearing a face mask during all endoscopies. Finally, all patients should be treated equally in terms of protective measures taken.