Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
AIDS AND THE HEALTH-CARE WORKER: MANAGEMENT OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION IN THE HEALTH-CARE SETTING
AIDS Updates; 1(1):1-12 1988. Unique Identifier : AIDSLINE ICDB/89657615 Henderson DK; Hosp. Epidemiology Service, Warren Grant Magnuson Clinical; Center, NIH, Bethesda, MD
Abstract:
With the discovery of the agent responsible for AIDS and the subsequent development of serologic tests for antibodies directed against HIV-1, it has become possible to assess more clearly the risk for occupational/nosocomial transmission of the virus. The seropositivity rates of health-care workers (HCWs) have been shown to be very low relative to the population at large. As of May 1988, 236 cases of AIDS in HCWs had been reported to the Centers for Disease Control as having occurred in HCWs who reported no known risk for HIV-1. Investigations completed in 124 of these cases resulted in 84 being reclassified into traditional risk-behavior categories. While 40 cases remained in the 'no identified risk' group, there are reasons to believe that some of these individuals also may have engaged in risk behaviors. In case reports of 25 occupational/nosocomial HIV-1 infections that have been published, 17 individuals who sustained injuries were followed prospectively and were shown to seroconvert later. In 10 prospective studies of HCWs exposed to body fluids (1320 HCWs are being followed who have reported 1389 percutaneous exposures to blood or other body fluids of a patient (pt) known to be infected with HIV-1), there have been 5 occupationally related seroconversions. No seroconversions have been reported in 8 longitudinal prospective studies involving 538 HCWs who reported 921 mucous membrane exposures to blood or other body fluids. A summary is presented of Universal Precautions, issued for prevention of HIV-1 infection among HCWs, that cover clothing, isolation of pts, management of equipment that may be contaminated, clean-up of blood and body fluid spills, and compliance management. Specific precautions that deserve special emphasis are discussed: management of needles and sharp objects, decontamination and sterilization, support services and waste disposal, and compliance. Areas of controversy in the prevention of HIV-1 infection among HCWs include management of employees who have sustained adverse exposures to blood or other blood-containing body fluids, management of HIV-1-infected HCWs, HIV-1 antibody testing of pts, and the right of HCWs to refuse to care for HIV-1-infected pts. (105 Refs)
Keywords: Acquired Immunodeficiency Syndrome/PREVENTION & CONTROL/ *TRANSMISSION Cross Infection/PREVENTION & CONTROL/TRANSMISSION Cross-Sectional Studies *Health Occupations Human HIV Seropositivity/TRANSMISSION HIV-1/*PATHOGENICITY Longitudinal Studies Occupational Diseases/PREVENTION & CONTROL/*TRANSMISSION Prospective Studies Risk Factors JOURNAL ARTICLE REVIEW, TUTORIAL REVIEW 891230
M89C0823
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Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
