To the Editor.
—Dr Orentlicher1 effectively underscored the need to address many issues surrounding the intraoperative transmission of the human immunodeficiency virus (HIV). Little dialogue has surfaced regarding the possibility of virtual elimination of risk through modification of surgical technique. The transfer of body fluids in the operating room can occur when a sharp instrument, usually a solid surgical needle, penetrates both the patient's skin and the surgeon's gloved hand. During an operation, the surgeon's dominant hand holds a scalpel, needle holder, or scissors and therefore makes no contact with the surgical needle, while the nondominant hand (1) exerts counterpressure to propel the needle through the tissues, (2) extracts the needle from the wound, (3) pulls the suture through the tissues, and (4) positions the needle in the jaws of the needle holder. It is in the performance of these four maneuvers that percutaneous needle injuries occur. A surgical
Burget GC, Orane AM, Teplica D. HIV-Infected Surgeons. JAMA. 1992;267(6):803. doi:10.1001/jama.1992.03480060049015