Testing of Specific Population Groups:
Health Care Workers and Testing

Q. What should a health care worker do if he/she has an occupational exposure?

A. Any health care worker who believes he/she may have been exposed to HIV should first contact the infection control coordinator or specialist at his/her place of employment. Any questions or concerns need to be directed to the individual's state OSHA (Occupational Safety and Health Administration) representative. The occupational safety personnel and OSHA will assist the health care worker in determining if and when he/she should be tested and what kind or procedures need to be followed.

Occupational health and safety information can be received by recorded message or FAX by calling the CDC Voice Information System at (404)-332-4555. The following CDC documents address occupational exposure. These documents are available from the CDC National AIDS Clearinghouse by calling 1-800-458-5231 or through the Clearinghouse's Internet Order Form. The following documents are in PDF format which is only viewable/downloadable using the Adobe™ Acrobat™ Reader. The Reader can be downloaded for free from Adobe Systems Incorporated.

Q. What is the law regarding testing of health care workers?

A. There is no federal law that mandates the national testing of health professionals for HIV. The Americans with Disabilities Act of 1990 (16) is a federal law that imposes limitations on medical examinations and inquiries an employer may make about disabilities, including HIV/AIDS. Typically, this federal law prohibits health care employers from mandating testing of all their employees for HIV/AIDS. Currently, court cases involving HIV-infected health care workers alleging discrimination under the ADA are handled on an individual basis. Neither the American Medical Association nor the American Hospital Association advocate mandatory testing of health care workers.

At least 17 states (California, Florida, Hawaii, Iowa, Illinois, Indiana, Louisiana, Maryland, Minnesota, Missouri, Montana, New Hampshire, New York, Ohio, Oklahoma, South Carolina, and Texas) have passed legislation to "protect patients from HIV-infected health care workers." At least eight states (Iowa, Minnesota, Missouri, New Hampshire, New York, Oklahoma, South Carolina, and Texas) have laws that establish expert review panels to determine, on a case-by-case basis, the circumstances, if any, in which a HIV-infected health worker may perform exposure-prone procedures. (11) At least three states (Oregon, Virginia, and West Virginia) allow HIV testing of health care workers who may have exposed a patient to HIV. (11) State laws are subject to change. Call the CDC National AIDS Clearinghouse for the most up-to-date information.

Q. Does a health care worker have the right to know if he/she is treating an HIV-positive person?

A. An individual's HIV status is private and at least 39 states have laws providing for the confidentiality of HIV/AIDS related information. Similarly, 28 states have laws that specifically regulate medical records and the remaining states protect confidentiality of HIV information under other statutes. However, almost every state allows for disclosure of HIV-related information in certain circumstances, such as cases of significant occupational exposure. The most frequently cited permission to disclose is given to health care providers involved with a patient's care. At least 38 states require informed consent prior to HIV testing of a patient. Increasingly, though, states have made exemptions to informed consent provisions. (15, 18) If consent cannot be obtained, HIV testing of patients in medical emergencies is allowed in at least 18 states (Arkansas, Connecticut, Delaware, Florida, Hawaii, Indiana, Iowa, Kentucky, Missouri, Montana, New Hampshire, New Mexico, North Dakota, North Carolina, Ohio, Pennsylvania, Rhode Island, and West Virginia) for treatment purposes or if there is a threat to public health. (11) State laws are subject to change. Call the CDC National AIDS Clearinghouse for the most up-to-date information.

Q. Does a patient have the right to know if his/her health care worker is HIV infected?

A. Again, an individual's HIV status is private and confidential. In fact, most states have penalties for unauthorized disclosure of this type of information. However, at least 17 states (California, Florida, Hawaii, Iowa, Illinois, Indiana , Louisiana, Maryland, Minnesota, Missouri, Montana, New Hampshire, New York, Ohio, Oklahoma, South Carolina, and Texas) have passed legislation to "protect patients from HIV infected health care workers." At least eight states (Iowa, Minnesota, Missouri, New Hampshire, New York, Oklahoma, South Carolina, and Texas) have laws that establish expert review panels to determine, on a case-by-case basis, the circumstances, if any, in which an HIV-infected health worker may perform exposure-prone procedures. (11) Universal precautions guidelines and infection control procedures are in place to prevent HIV transmission from an HIV-infected health-care worker to a patient. There is only one documented incident of patients being infected by a health care worker, the case of a Florida dentist, who infected six of his patients. However, it is not clear how the patients were infected. More then 22,000 patients of 63 HIV-infected doctors and dentists have been investigated, with no other cases of transmission attributed to medical or dental procedures. (19)

At least three states (Oregon, Virginia, and West Virginia) allow HIV testing of health care providers who may have exposed a patient to HIV. Otherwise, except in exempted circumstances, forced or mandated HIV testing violates constitutional protections against unwarranted search and seizure. (11) State laws are subject to change. Call the CDC National AIDS Clearinghouse for the most up-to-date information.

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