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Makovicka and colleagues [13] compared three surgical-gowning systems in terms of how they protected healthcare workers from exposure to particulate debris during cadaveric TKA. They found that wearing a positivepressure exhaust suit produced less exposure to TKA debris compared to conventional surgical masks and protective eyewear, which still allowed debris exposures on the nostrils, lips, and eyes of the surgeon. These results support an earlier finding that also reported less particulate exposure on the skin and mucosa of test subjects wearing positive-pressure exhaust suit compared to conventional gown-andmask clothing when performing simulated joint replacement surgery [17]. Although the use of a positivepressure exhaust suit during joint replacement surgery remains controversial due to associations with intraoperative air contamination and increased incidence of deep infection [19], the findings from these studies stimulate interest in understanding more about the intraoperative risks orthopaedic surgeons face in terms of blood-borne-pathogen (BBP) exposure, and whether any alternatives to positive-pressure exhaust suit use, such as universal preoperative patient screening for BBPs, could be more effective in reducing risks to both patients and healthcare workers. Orthopaedic surgeons are at high risk for exposure to BBPs during surgery, especially during arthroplasty procedures where splashes of blood and bloody materials occur in virtually every procedure [1]. While the combination of mandatory practitioner Hepatitis B vaccination and low disease transmission risks of Hepatitis C and human immunodeficiency virus (HIV) through mucocutaneous exposure are reassuring [12], the actual quantitative risk of BBP transmission from patient to healthcare workers remains unknown and is likely higher than what most medical professionals believe. There are two reasons for this: First, the prevalence of transmissible BBPs including Hepatitis B, C, and HIV in the United States has risen notably over the last two decades [4, 7, 11], affecting up to 5 million individuals that comprise up to 1.5% of the population. Second, the actual prevalence of splash, needlestick, and/or sharps injuries among the surgical subspecialties is unacceptably high, with reports ranging from 40% [10] to 100% [2] of survey respondents. Students and trainees are especially at risk, with 83% of orthopaedic residents and fellows admitting to being exposed to a splash, needlestick, or sharp injury at least once during their training [10]. The true incidence of exposure injuries is believed to be higher than published values due to increasing orthopaedic case volumes and a tendency to underreport injuries secondary to fear of social, clinical, or legal implications that could occur by undergoing testing [16]. Interestingly, the topic of patient screening for BBPs prior to elective surgery is minimally discussed in the This CORR Insights is a commentary on the article “Surgeon Personal Protection: An Underappreciated Benefit of Positivepressure Exhaust Suits” by Makovicka and colleagues available at: DOI: 10.1007/ s11999.0000000000000253. The author certifies that neither he, nor any members of his immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999. 0000000000000253. Alberto V. Carli MD, MSc, FRCSC (✉), The Ottawa Hospital 501 Smyth Road CCW 1642 Ottawa ON, K1H 8L6, Canada Email: [email protected] A. V. Carli, Assistant Professor, Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada