Herpetic Whitlow: An Occupational Hazard for Anesthesia Providers

Herpetic whitlow (HW) is a herpes simplex virus (HSV) infection of the hand, usually of the distal phalanx soft tissue adjacent to the nail. The disease can be acquired by contact with infected oral mucous membranes, saliva, or respiratory secretions that harbor the virus. HSV then enters the digital skin via a clinical or subclinical abrasion in the epidermis. As such, HW is an occupational hazard for anesthesia providers – in addition to several other healthcare professions – associated with recurrent unprotected or inadequately protected hand exposure to oral mucosa and secretions, and as such, it is largely preventable. The widespread problem of unhygienic habits involving lack of glove usage or improper usage among anesthesia providers likely fosters the occurrence of HW in this population, and this behavior is partly related to the frequent need to perform multiple airway-associated interventions in a timely manner in many anesthesia practices. Despite its causal relationship with the practice of clinical anesthesia, there has been very little discussion of this disease process in the anesthesia literature during the past two decades, and this absence of an academic forum may relate to a more generalized insensitivity of many anesthesia providers to some occupational hazards of their profession.

Keywords: Herpetic whitlow; Herpes simplex; Occupational hazard; Anesthesia.