Koop Urges That All Surgical Patients Take AIDS Test

Surgeon General C. Everett Koop urged Thursday that all patients admitted to hospitals for surgery be tested for exposure to the AIDS virus, saying that operating room personnel are leaving their professions “because of the fear.”

“I think the day is not far off when the testing of surgical patients will become much more routine,” he said in testimony before Congress. “There will be a growing demand for the testing of surgical patients.”

Needle-Stick Injuries

Physicians and nurses in operating rooms are subject to potential needle-stick injuries and exposure to large amounts of blood, situations in which acquired immune deficiency syndrome could be “readily transmissible,” he said.

Koop, addressing members of the House Select Committee on Children, Youth and Families on the subject of AIDS and teen-agers, made his remarks in response to a question about the right of health care workers to know whether patients are infected with the virus. He did not elaborate.

Koop did not address the issue of confidentiality of test results and how such information would be kept private within the hospital.

Hippocratic Oath Cited

The surgeon general stressed later through a spokesman that test results should not be used by surgeons as a reason to refuse to operate on infected patients.

“Under the Hippocratic Oath, doctors should take care of their patients,” Koop said through Public Health Service spokesman James Brown, who added that Koop--a former pediatric surgeon--had made the recommendation “not as surgeon general, but as a surgeon.”

Federal health officials have not yet formally recommended that surgical patients undergo the procedure, but Brown said that “we are looking at it.”

“We’ve been getting a lot of reports of nurses and others leaving the field because they don’t want to operate in this area,” Brown said.

“There are things that occur in the operating room that people have to take precautions against. You should be following precautions anyway, but, if you know somebody has the virus, you should be extra careful.”

A spokeswoman for the American College of Surgeons said the organization’s governing board is deliberating a policy recommendation regarding the testing of patients for AIDS infection, expected sometime this summer. She said college officials would have no comment on Koop’s suggestion until then.

“From what I’ve seen come across my desk so far, everyone is divided,” she said. “There is no consensus.”

In Orange County, Koop’s comments were met with guarded reaction at three hospitals.

Dr. John Applegate, chief of medical staff at Hoag Memorial Hospital Presbyterian in Newport Beach, said the hospital is asking all departments that perform surgery to review Koop’s position and to report back to the medical executive committee.

Personally, Applegate said, he tends to agree with Koopz:”I think the epidemic is becoming large enough, and there are enough patients now with this disease that we have to have real concern for the health care workers.”

Hospitals, he said, “owe them some protection” by at least giving health care workers more complete information about the medical conditions of the patients they are handling.

Dr. Robert Mason, chief of general surgery at UC Irvine Medical Center, said he also personally agreed with the surgeon general. The university hospital and Hoag treat the bulk the county’s AIDS patients.

“As with any infectious disease, we do better by knowing more and taking better precautions,” Mason said. “It helps both the health care professionals and the patients.”

At St. Joseph Hospital in Orange, spokesman Dennis Gaschen said the staff would support “anything that would increase our ability to care for the patient. It just makes sense that the more you know (about a patient’s condition), the better you can care for him or her and provide for safety for the physicians and for other members of the hospital’s staff.”

It’s the same with other infectious diseases, such as hepatitis and tuberculosis, he said.

But he acknowledged that AIDS is “a very controversial and at this time undecided subject.” While it “is better to be informed,” Koop’s suggestion to test surgical patients runs counter to state law, which holds that the test results cannot be put on a patient’s chart unless the patient consents to it, Gaschen said.

The Public Health Service earlier this year considered recommending that all hospital patients be routinely screened for AIDS infection but rejected the suggestion because, among other reasons, many hospital patients, such as the elderly and children, are not among those at highest risk for the illness.

Gloves Recommended

Federal health officials have already recommended that all health care workers take precautions, such as wearing gloves, when treating AIDS patients and have emphasized that medical personnel should routinely take special care when handling the blood and body fluids of all patients, even if they are not known to be infected.

Last month, federal officials reported three cases in which health care workers--who were not wearing gloves--became infected after a single but extensive accidental exposure to the blood of AIDS patients.

Meanwhile, under a new program announced Thursday at Cook County Hospital in Chicago, physicians, nurses and other health care workers will be required to wear rubber gloves, masks, goggles and gowns whenever they come in contact with the body fluids of any patient, not just patients with AIDS.

Used by Few Hospitals

“As far as I know, there are only about three other hospitals in the country using this program,” a hospital spokesman said. “It’s not a widespread practice yet, but I expect it will be.”

AIDS destroys the body’s immune system, leaving it powerless against certain cancers and otherwise-rare infections. The virus can also invade the central nervous system, causing severe neurological disorders. It is commonly transmitted through sexual intercourse, through the sharing of unsterilized hypodermic needles and by woman to fetus during pregnancy.