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September 11, 1991

Surgery, AIDS, and Hepatitis B

Author Affiliations

Harvard Medical School Boston, Mass

Harvard Medical School Boston, Mass

JAMA. 1991;266(10):1361. doi:10.1001/jama.1991.03470100052027

To the Editor.  —The recent article by Panlilio et al1 and the accompanying editorial by Drs Gerberding and Schecter2 draw attention to existing rates of blood exposure in operating rooms. These authors make suggestions regarding efforts to reduce blood exposure. Their suggestions seem sensible.However, before rushing into massive implementation of extraordinary restrictions, more data should be obtained. The amount of blood is likely to be only one factor in transmitting infection. We know that a microscopic amount of blood can also have an enormous impact. Several cases of physician-acquired HIV infection have occurred with small quantities of blood. The Florida dentist's transmission of HIV to patients also indicates that minute quantities of blood in the mouth or in the presence of oral injuries may be exceedingly potent. Factors like the depth of injury, the quantity of virus, the infectious potential of the virus, and perhaps even the