Health Care workers and the Risk of HIV Transmission

Health Care Workers and the Risk of HIV Transmission In the last decade, tens of thousands of persons with acquired immunodeficiency syndrome (AIDS) have been treated in the health care system in the United States. Hundreds of thousands more infected with human immunodeficiency virus (HIV) but often not identified as such have also received medical, dental and nursing services. Although isolated cases of HIV infection in health care personnel have created a high level of anxiety about the risk of treating such patients, the actual probability of contracting infection is extremely small. The first descriptions of persons with the disease now known as AIDS were reported to the Centers for Disease Control (CDC) in the spring of 1981. [1] It was not until the fall of 1982, however, when more than 600 cases had been reported, that cumulative epidemiologic data strongly suggested that AIDS was caused by a transmissible (infectious) agent. In response CDC published the first recommended precautions for clinical and laboratory personnel working with persons with AIDS or associated conditions (specified as chronic, generalized lymphadenopathy, unexplained weight loss, and/or prolonged unexplained fever in persons at risk for AIDS). [2] This report noted that at that time there was "no evidence of AIDS transmission to hospital personnel from contact with affected patients or clinical specimens." The patterns of transmission for the unknown agent that caused AIDS appeared similar to those of hepatitis B virus (HBV), however, and hospital personnel were advised to use the same precautions when providing care for a person with AIDS as for those with HBV. To document the risk of infection to health care workers, several prospective studies were initiated in which personnel working with patients with AIDS or who had been inadvertently exposed to blood or other body fluids of patients were evaluated for evidence of illness. Once HIV was identified as the cause of AIDS and serologic tests for determining antibody status became available in 1985, these studies had a more rapid and sensitive marker to confirm infection acquired in the workplace. These studies and anecdotal reports published over the last four years have documented that HIV can be transmitted to health care workers, although such occurrences are extremely infrequent. Virtually all confirmed infections occurred after an accidental injury, most often by injury from a needle that had been used on a patient. In May 1987, however, a report documented HIV infection in three health care workers who had been exposed to blood from a person with HIV infection only on their skin or mucous membranes. [3] The anxiety engendered by this report has been unmistakable, and has given rise not only to broadened recommendations to try to prevent this type of exposure, [4] but also to inappropriate suggestions for management of persons with AIDS or HIV infection in health care settings. If there were a significantly increased risk of AIDS to health care workers because of occupational exposure, one would expect a higher percentage of persons with AIDS to be employed in health care when compared with other professions. Almost 50,000 adults in the United States had been diagnosed with AIDS and reported to the CDC through December 1987. Selected information about employment is available for approximately 86 percent of the first 40,000 cases. * In cases with known employment information, 2,232 (5.6%) reported employment in a health care setting before or at the time of diagnosis. * Almost precisely the same proportion of persons in the total labor force are reported to be employed in health services. [5] The age, race, and sex distribution of persons with AIDS employed in health services is similar to that of all AIDS cases. Most (95.1%) have a risk factor for HIV infection unrelated to employment. Persons with AIDS who are initially reported not to have a risk factor for infection are investigated intensively by state or local health departments to determine a probable means of HIV infection. …