Miami Herald (MH) - Tuesday, July 16, 1991
Elinor Burkett; Herald Staff Writer

Despite rising public concern that health care workers might infect patients, the Centers for Disease Control did not call for mandatory testing but returned to an old theme: the need for meticulous infection-control procedures.

"We must get across to the public that in most medical situations there's no more risk from a potentially HIV-infected nurse or doctor than from a lawyer, cab driver or teacher," said Dr. James Mason, U.S. Public Health Service head.

"However, when surgery is performed, patients need to know that they will be protected by their dentists and physicians scrupulously following the universal precautions and recommended infection controls -- such as the sterilization of equipment, use of gloves and proper care of sharp instruments."

The CDC called on physicians who do "exposure-prone" procedures to undergo AIDS testing. Such procedures include abdominal, gynecological or heart surgery, root canals or tooth extractions, said Dr. Louis Sullivan, secretary of Health and Human Services.

Health professionals who work in these areas and test positive should avoid risky procedures unless they inform patients and have the advice of an expert review panel. The guidelines call for such panels to be established across the country.

The recommendations follow months of debate provoked by the cases of five Floridians infected with HIV in the office of Dr. David Acer of Stuart. There have been no other cases of patients contracting the virus in a health care setting, according to the CDC.

It remains unclear whether Acer infected the five directly, as originally believed, or by using nonsterile equipment. The AIDS virus is transmitted through sexual contact, blood transfusion or sharing of infected needles.

Despite the CDC recommendations, experts predict that more restrictive policies, including mandatory testing of all surgeons, will become common in hospitals because of the threat of lawsuits.

"It's quite possible," said John Ross of the American Hospital Association. "Hospitals are community institutions, and I think we can expect that different hospitals will have different standards."

Some members of the medical community insist that the Acer case has been blown out of proportion and that testing health workers is pointless.

"As individuals we all want the most risk-free possible environment, but the risk is already infinitesimal," said Dr. Mervyn Silverman, president of the American Foundation for AIDS Research. "Testing might reduce that risk a tad, but at what cost? How often should physicians be tested? . . . We all know you can test negative today and still be infected.

"We also know that you can be negative and still infect your patients through sloppy infection control.

"The problem is that the exception has become the rule and the rule has been forgotten. The rule is that hundreds of thousands have been treated by HIV-infected health care workers with no problem. The exception is that five patients were infected by one dentist who wasn't careful with his equipment."

But one exception, Acer's patient Kimberly Bergalis, now near death, insisted that patients deserve more protection than voluntary guidelines offer. "If laws are not formed to provide protection, then my suffering and death was in vain," she wrote in April.

Always watch for outdated information. This article first appeared in 1991. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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