Do a routine operation, why do you want to check syphilis and AIDS?

[Q] Ms. Zhang, a citizen, asked: Recently, when she went to the hospital for surgery, she was asked to have syphilis and AIDS tests. She felt insulted and wanted to ask if the hospital did this to earn examination fees.

[A] Chia an Answer, West China Clinical Medical College, Sichuan University, Ms. Zhang, a citizen:

I am very curious why there are so many routine examination items before surgery, and why do you keep a close eye on syphilis and AIDS? Why don’t you question why you have to check urine and feces and liver and kidney functions before surgery? They are all inspections. Why is there such a big difference? Syphilis and AIDS are estimated to be so wronged that they will cry … [I won’t fool around outside, why do you check these for me? ] [How old do you want to check for AIDS? More than 90-year-old people also need to check syphilis? The hospital is really dark…] Apart from the expenses, More attention has been paid to screening for syphilis, AIDS, I think I feel that this kind of examination is offensive or even insulting to myself. Well, Then I will replace syphilis, AIDS and hospitals [wash white]. Almost all qualified hospitals in our country have to check hepatitis B, hepatitis C, syphilis and AIDS routinely before patients undergo surgery or invasive operations, commonly known as [four items before surgery]. This is due to careful consideration of patients, medical care and hospital management.

1. Patients

No matter how big or small the operation is, it will cause certain injuries to the patient. Only by comprehensively evaluating the patient’s condition and selecting appropriate operation methods and emergency measures can the smooth implementation of the operation be ensured, which is conducive to the recovery of the patient.

Take AIDS as an example, If the surgical patient suffers from AIDS, Immunity will be much lower than that of ordinary people. Doctors do not know how to treat it as a normal person. Hands up and knives down, He made a big cut in his body, All kinds of germs poured in during the operation and the recovery process after the operation, Then wait for all kinds of fever and infection, It may even be fatal. So unless there are special circumstances, Conservative treatment is generally recommended. Hepatitis virus can damage liver function, It will also affect the tolerance of the operation. Therefore, preoperative examination should be conducted to determine whether the patient has any other diseases that affect the operation. It is very important to choose a reasonable treatment method. Doctors will consider whether to treat hepatitis or AIDS first. When the body recovers to be able to withstand the surgical blow, the operation will be carried out again. AIDS patients will also pay special attention to the cleaning of operating rooms and instruments before surgery. To further avoid intraoperative infection. After all, surgery is to treat diseases, No one wants to be on the operating table but can’t get down. Besides, Although modern medicine emphasizes the principle of universal prevention (treating each patient as a potential source of infection), However, it is inevitable that there will be no mistakes in the actual operation process. Hepatitis B, hepatitis C, syphilis and AIDS are all easy to spread through body fluids such as blood. If the body fluids of the previous patient contaminate the operating table, If the next patient is not properly cleaned, the next patient will be very dangerous. Therefore, if the patient is known to suffer from these diseases before operation, the postoperative medical care will clean the operating room, surgical instruments, wards, etc. more carefully and seriously, and the generated medical waste will also be specially treated to ensure the safety of other patients.

2. Medical workers

In addition to the patient’s preparation for an operation, Medical staff should also be prepared. In addition to infectious disease specialists, Doctors and nurses in other departments do not know much more about infectious diseases than ordinary people. Fortunately, however, most medical staff do not exclude the treatment of patients suffering from infectious diseases. The patient was diagnosed with infectious diseases before surgery. During the treatment process, medical staff will be more careful to protect themselves. For example, surgeons often wear double gloves, goggles and anti-leakage surgical gowns. Nurses will try their best to avoid needle injuries when giving injections to patients.

This is not discrimination. Doctors and nurses are also ordinary people. They also have their own worries and worries. If doctors and nurses cannot protect themselves well, which patient is willing to entrust their bodies to them? In fact, every day clinically, doctors and nurses are accidentally punctured by needles, cut by scalpels or let blood (body fluids) splash into eyes. This kind of situation we call [occupational exposure]. Once occupational exposure occurs, if we know in advance what infectious diseases the patient suffers from and take timely measures, doctors and nurses can be prevented from being infected to the greatest extent.

Because of the universality of this situation, on December 30, 2013, the National Health and Family Planning Commission and other departments officially included [AIDS (limited to medical and health personnel and people’s police)] in the “Classification and Catalogue of Occupational Diseases” in order to better protect the rights and interests of medical and health personnel.

3. Hospital and public health management

The National Law on the Prevention and Control of Infectious Diseases classifies infectious diseases into three categories: A, B and C, totaling more than 30 kinds. Among them, hepatitis B, hepatitis C, syphilis and AIDS all belong to Class B infectious diseases. Requires [strict management]. From the perspective of public health, [Four items before operation] is necessary. There are more than 100 million hepatitis B virus carriers in China, The incidence of hepatitis C, AIDS and syphilis is also rising rapidly. Almost every day, some people in the hospital where I work are found to be infected with these four bad guys due to preoperative examination. The transmission routes of these four diseases are blood, mother and infant, sex, In other words, it is completely impossible to find it without special examination, which is a big hidden danger to personal health and social public safety.

If the mother had syphilis, AIDS before pregnancy, There has been no examination and treatment during pregnancy and childbirth, Children have a high risk of infection, And it can not develop until the age of 13 or 14. On the other hand, Because teenagers have sex for the first time earlier and earlier, Cases of HIV and syphilis among students through sexual transmission are not uncommon. For the elderly, People used to take it for granted that people had no sexual needs when they were old. Until recent years, there have been explosive cases of syphilis and AIDS among the elderly due to unsafe sex. Only then did we realize that the prevention and control of infectious diseases does not make any distinction between sex, age, race or occupation. The state cannot force all people to have infectious disease tests. Routine examination before surgery is an effective screening method. In addition, Proceeding from reality, Many patients may encounter the need for blood transfusion during surgery. Although the management of blood products in our country is now very strict, There are few cases of blood transfusion infection with hepatitis B, AIDS and other diseases, but there is no 100% guarantee that these diseases will not be infected due to blood transfusion. In case the patient suffers from these diseases after the operation, and the relevant examination is not done before the operation to eliminate them, who can say clearly whether the patient got sick before or the iatrogenic infection caused by the operation? In this case, Doctor, hospitals have to face lawsuits or even have their medical licenses revoked. So even emergency surgery, In order to avoid potential risks, The patient’s blood sample was left for examination as soon as possible. For a rainy day. No matter what the reason is, the public has misunderstood the [four preoperative examinations], It shows that the doctor-patient communication is not in place from the side. If the surgeon can effectively explain and communicate with the patient before the examination, To ensure the patient’s right to know, I believe most patients can understand and support it. Doctors pay attention to not only the patient’s health, but also their own health. Hospital managers will also pay attention to avoid unnecessary risks. This is reasonable. Preoperative routine examination of hepatitis B, hepatitis C, syphilis and AIDS is in line with the common interests of all parties.

The society is progressing. Only through continuous communication and understanding can rumors not have a breeding ground and mutual trust between doctors and patients can be gradually rebuilt.