Infection prevention and control in the era of the AIDS/HIV epidemic

Abstract The chronology of important events in the AIDS/HIV epidemic is presented in Table 2. Nurses are the largest group of health care workers and persons who provide direct care and handle sharp objects regularly. As the number of persons infected with HIV increases and as more infected persons become ill enough to require care, the opportunity for an individual nurse to have contact with an infected person will increase. Because many persons with HIV infection also have Kaposi's sarcoma and other malignancies, some oncology nurses may have more contact with HIV-infected individuals than nurses in general. However, it is well established that the major risk for HIV infection is from puncture injuries, and a number of strategies are available and are being developed to make needle and sharps handling safer. Nurses must take personal responsibility for 2 . Chronology of Events in the AIDS/HIV Epidemic ∗ Mo/Yr Event 6/81 First case reports of persons with AIDS published (five homosexual men) 1 1981 Syndrome called Gay-Related Immune Disease (GRID) 12/81 First case of AIDS reported in a woman (an IV drug user) 4/82 CDC AIDS case count = 300 6/82 First case of AIDS reported in a hemophiliac 7/82 Syndrome named Acquired Immunodeficiency Syndrome (AIDS) 8/82 First case of AIDS reported in a blood transfusion recipient First case of AIDS reported in an infant 1/83 First cases of AIDS reported in female sexual contacts of men with AIDS 2/83 CDC AIDS case count = >1,000 5/83 Virus identified at Pasteur Institute, Paris, France, and reported in Science 7 9/83 CDC publishes precautions for health care workers 34 1/84 CDC AIDS case count = >3,000 7/84 CDC AIDS case count = >5,000 12/84 First case of occupational transmission of the virus reported (puncture injury) 9 2/85 CDC AIDS case count = >8,000 3/85 Antibody test to detect virus licensed for use by blood banks 4/85 CDC AIDS case count = >10,000 7/85 Announcement that Rock Hudson, the actor, was ill with AIDS 8/85 First International Conference on AIDS, Atlanta (>2,000 in attendance) 1986 Institute of Medicine/National Academy of Sciences publishes Confronting AIDS 35 6/86 Second International Conference on AIDS, Paris, France 9/86 Azidothymidine (AZT) licensed as a therapeutic agent for persons with Pneumocystis pneumonia 1987 Name of virus standardized to Human Immunodeficiency Virus (HIV) 5/87 CDC reports three cases of nonparenteral occupational transmission of HIV to health care workers 13 6/87 Third International Conference on AIDS, Washington, DC 7/87 CDC AIDS case count = >40,000 8/87 CDC case definition for AIDS revised 36 8/87 CDC publishes detailed recommendations for prevention of HIV infection in health care workers 15 10/87 Department of Labor and Department of Health and Human Services publish “Joint Advisory Notice” of proposed rule to reduce risks of transmission of HIV/HBV and blood-borne agents to health care workers 16 6/88 Fourth International Conference on AIDS, Stockholm, Sweden, (>7,000 in attendance) 6/88 Report of the Presidential Commission on the HIV Epidemic published 37 6/88 CDC revises recommendations for “universal precautions” 20 1988 IOM/NAS publish Confronting AIDS: Update 1988 38 1989 National Research Council publishes AIDS: Sexual Behavior and Intravenous Drug Abuse 39 6/89 Fifth International Conference on AIDS, Montreal, Canada, (>10,000 in attendance) 1/90 Projected CDC AIDS case count = >100,000 1990 OSHA rulemaking completion expected; new regulations will enable OSHA to cite and fine facilities not in compliance with specific rule to reduce risks to health care workers for HIV/HBV and other blood-borne agents. 6/90 Sixth International Conference on AIDS, San Francisco, CA, (>15,000 expected) ∗ Some dates and information are taken from Shuts. 33 knowing how to reduce their own risks for exposure to HIV and other infectious agents while keeping in mind the need not to increase risks of nosocomial infections in patients. Thus, all nurses need a comprehensive understanding of the purposes of barriers (eg, gloves, gowns, masks, hand-washing, room assignment) and when and how to use them correctly. In addition, all nurses who have contact with blood and body fluids should take responsibility for their own immunity to hepatitis B by obtaining hepatitis B vaccination. By using all of these strategies in combination, many infection risks to nurses and patients will be minimized.