Correspondence

Electric Razors as a Potential Vector for Viral Hepatitis

N Engl J Med 2000; 342:1840-1841June 15, 2000

Article

To the Editor:

We thank Dr. Kelly (March 9 issue)1 for her vigilance on behalf of veterans treated by the Department of Veterans Affairs. Her suggestion that the sharing of electric razors might be responsible for the relatively high rates of viral hepatitis among veterans is provocative but seems implausible. In the large seroepidemiologic study that she cited, military service was an insignificant risk factor for hepatitis B infection relative to other considerations.2 The brief letter noting an increased seroprevalence of antibodies to hepatitis C virus among Sicilian barbers concerned barbers who used a straight razor on both their patrons and themselves.3 Although we do not condone the sequential sharing of electric razors observed by Dr. Kelly,1 we think that the risk of hepatitis associated with such an event is very low from both an individual and an epidemiologic perspective.

The policy at our medical center is that patients who ask to shave themselves are to be given disposable, single-use, safety razors whenever possible. However, many of our patients have an increased risk of bleeding because they are receiving therapeutic anticoagulation or cancer chemotherapy or because they have advanced liver disease; others have impaired coordination as a result of neurologic disorders. Consequently, the policy allows such patients to be given an electric razor, which is to be returned directly after use and is to be thoroughly cleaned before being given to another patient. The episode described by Dr. Kelly — one patient picks up the electric razor that another patient has just put down — represents a clear violation of this procedure despite continued teaching and reinforcement of the practice.

Dr. Kelly's observation has led us to review our current practices. We have concluded that in our acute care hospital, the use of electric razors is sufficiently limited that we can issue a new or sterilized electric razor to each person who needs one during hospitalization. The electric razor will be labeled with the patient's name, and the need to avoid sharing razors will be strictly emphasized.

Robert D. Arbeit, M.D.
Richard P. Goodman, M.D.
Gordon L. Snider, M.D.
Veterans Affairs Boston Healthcare System, Boston, MA 02130-4893

3 References

1. 1

   Kelly CR. Electric razors as a potential vector for viral hepatitis. N Engl J Med 2000;342:744-745
   Full Text | Web of Science | Medline

2. 2

   McQuillan GM, Coleman PJ, Kruszon-Moran D, Moyer LA, Lambert SB, Margolis HS. Prevalence of hepatitis B virus infection in the United States: the National Health and Nutrition Examination Surveys, 1976 through 1994. Am J Public Health 1999;89:14-18
   Web of Science | Medline

3. 3

   Tumminelli F, Marcellin P, Rizzo S, et al. Shaving as potential source of hepatitis C virus infection. Lancet 1995;345:658-658
   CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Kelly replies:

To the Editor: I am pleased that my observation prompted a review of the policy and practices at the Veterans Affairs hospital. Since the letter appeared, the hospital staff has been vigilant about sterilizing electric razors after patients have used them. I hope that other health care facilities where these devices are in use will follow the example set by this hospital to provide further protection to patients.

I agree that the risk of disease transmission associated with the sharing of electric razors is probably very low, but nonetheless, it should not be dismissed. The statement of Arbeit et al. that patients who “have an increased risk of bleeding,” including those with “advanced liver disease,” are the patients who are very likely to be using these razors strengthens the argument that the devices could be contaminated with diseased blood.

It was not my intent to imply that electric razors are responsible for the high rates of viral hepatitis among veterans. I cited the statistics1 only to underscore that the sharing of razors poses a greater risk in a population in which the prevalence of disease is high.

Colleen R. Kelly, M.D.
Boston Medical Center, Boston, MA 02118

1 References

1. 1

   Mendenhall CL, Seeff L, Diehl AM, et al. Antibodies to hepatitis B virus and hepatitis C virus in alcoholic hepatitis and cirrhosis: their prevalence and clinical relevance. Hepatology 1991;14:581-589
   CrossRef | Web of Science | Medline