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BACKGROUND:
AIDS and U.S. Hispanics
CDC's Role
Combating Complacency
Drug Use and Sexual
HIV Transmission

The Global Epidemic
HIV Prevention for
African Americans

Linking Science & Prev.
Occupational HIV
Transmission

Perinatal HIV Prevention
Prevention and Treatment
of STDs

Prevention for Minority
and Young Women

TB and HIV
Treatment Advances
Young and Minority Men
at High Risk

Young People at Risk
 
Preventing Occupational HIV Transmission To Health Care Workers

As of December 1997, CDC is aware of 54 HCWs in the United States who have had documented HIV seroconversion following occupational exposures, which means they tested negative for HIV infection around the time of exposure, but tested HIV positive within a year after the exposure. Another 132 HIV-infected health care workers have been classified as possible cases of occupational transmission. These 132 health care workers have a history of occupational exposure to blood, other body fluids, or HIV-infected laboratory material and report no other risk factors for HIV infection, but do not have documentation of seroconversion after the occupational exposure. U.S. Health Care Workers with Documented and Possible Occupationally Acquired HIV Infection and AIDS, Reported Through December 1997

Occupation Number of Occupational Transmissions
Documented Possible
Dental worker, including dentist 7
Embalmer/morgue technician 1 2
Emergency medical technician/paramedic - 12
Health aide/attendant 1 15
Housekeeper/maintenance worker 1 10
Laboratory technician (clinical) 16 18
Laboratory technician (nonclinical) 3 0
Nurse 22 32
Physician (nonsurgical) 6 11
Physician (surgical) - 6
Respiratory therapist 1 2
Technician (dialysis) 1 3
Technician (surgical) 2 2
Technician/therapist other than above 0 9
Other health care occupations - 3
TOTAL 54 132


Types of Exposures and Risk for HIV Transmission

Of the 54 HCWs with documented transmission, 46 (85%) were exposed to HIV through percutaneous injuries (injuries penetrating the skin, such as from a needle stick). Another 5 had mucocutaneous exposures (they were exposed to body fluids from an HIV-infected person through the mucous membranes or skin); 2 HCWs had both percutaneous and mucocutaneous exposures; and 1 had an unknown route of exposure. Forty-nine of the 54 HCWs were exposed to the blood of an HIV-infected person, 1 to visibly bloody fluid, 1 to an unspecified fluid, and 3 to concentrated virus in a laboratory. Studies suggest that several factors may affect the risk for HIV transmission through an occupational exposure, including the quantity of blood or body fluid, the concentration of HIV in the blood or fluid, and the exposed persons underlying health and immune status.


Preventive Strategies

The primary means of preventing the HCWs occupational exposure to HIV and other bloodborne pathogens is to follow infection control precautions with the assumption that the blood and other body fluids from all patients are potentially infectious. These precautions include the routine use of barriers (such as gloves and/or goggles) when anticipating contact with blood or body fluids, immediately washing hands and other skin surfaces after contact with blood or body fluids, and careful handling and disposal of sharp instruments during and after use.

Safety devices have also been developed to help prevent needlestick injuries. If used properly, these types of devices may reduce the risk of exposure to HIV through percutaneous injuries. Furthermore, because many percutaneous injuries are related to sharps disposal, strategies for safer disposal, including safer design of disposal containers and placement of containers, are being developed.

Although the most important approach toward reducing the risk of occupational HIV transmission is to prevent occupational exposures, there also should be plans for post-exposure management for HCWs. One consideration in post-exposure management is the administration of antiretrovirals as post-exposure prophylaxis (PEP). The use of zidovudine as PEP has been shown to be safe and associated with decreased risk for occupationally related HIV infection. Newer antiretrovirals also may be effective, although there is less experience with their use as PEP; therefore, data are continually being collected on the use of the newer antiretrovirals. CDC recently issued guidelines for the management of HCW exposures to HIV and recommendations for PEP. These guidelines outline a number of considerations in determining whether or not an HCW should receive PEP and in choosing the type of PEP regimen.


Building Better Prevention Programs for Health Care Workers

Continued work in the following areas is needed to reduce the risk of occupational HIV transmission to health care workers:

Continue administrative efforts. All health organizations should continue to support infection control measures that prevent HCWs from becoming exposed to blood and other body fluids. The training and monitoring of HCWs and the reporting of occupational exposures are essential to prevention efforts.

Develop and promote the use of safety devices. Effective and competitively priced safety devices are needed for HCWs who frequently come into contact with potentially HIV-infected blood and other body fluids. The use of safety devices should be evaluated to determine if they are being used properly and consistently.

Monitor the effects of PEP. More data are needed on the safety and tolerability of different regimens of PEP, particularly those regimens that consist of new antiretroviral agents. Furthermore, improved communication regarding side-effects before starting treatment and close follow-up of HCWs are needed to increase compliance with the PEP.

CDC, in collaboration with hospitals and other health care organizations, will continue to promote a safe and healthy health care work environment through surveillance activities, epidemiologic and laboratory research, and the development of guidelines and recommendations for the prevention and management of occupational exposures and infections in health care workers.


CDC Presentations Related to Health Care Workers

Orals "Tolerability of Antiretroviral Agents Used by Health Care Workers (HCWs) as Postexposure Prophylaxis (PEP) for Occupational Exposures to HIV," Adelisa Panlilio

Posters "Preventability of Occupational Exposures Resulting in Human Immunodeficiency Virus (HIV) Postexposure Prophylaxis," Denise Cardo/Adelisa Panlilio

"Characteristics of HIV-Positive Health Care Workers Reported with Tuberculosis in the United States, 1993 to 1996," Yvette Davis

   


    Combating Complacency - HIV Prevention, Geneva '98