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AIDS: medical groups balk at naming high-risk procedures.

AIDS: Medical groups balk at naming high-risk procedures

The Centers for Disease Control will have to devise its own lists of high-risk procedures the HIV-infected doctors and other health care workers should avoid.

Saying that the risk of transmitting the AIDS virus from health care workers to patients is insignificant, dozens of medical groups decided not to cooperate with the CDC in determining "exposure-prone" procedures, the New York Times reported.(1) The decision was made at a closed meeting held Aug. 28 at the American Medical Association headquarters in Chicago.

Most of the 40 medical, nursing, and other health care groups invited to the meeting declined to help develop such lists. They contended that new data showed there was no significant risk of infecting patients, according to M. Roy Schwarz, M.D., a vice president of the AMA.

"The prevailing attitude was that compiling a list implies there is a significant risk, and thus would mislead the public and capitulate to public fears," Schwarz told the Times. "Most of the representatives felt there was no scientific basis to do that."

Gary Noble, M.D., an AIDS expert at the CDC, said the prospect of having no lists "makes life more difficult" for the agency but that it intended to write directly to professional organizations.

In July, the CDC published revised guidelines that said health care workers should voluntarily test themselves for the viruses that cause AIDS and hepatitis B, and that those infected should stop doing certain "exposure-prone procedures" unless they got permission from a panel of experts and informed their patients. The CDC asked the professional groups to identify the procedures posing the greatest risks. Many health care experts are concerned about the chaos that could result if each hospital interprets the new Federal guidelines differently.

The CDC guidelines stemmed from an investigation by epidemilogists that found that Kimberly Bergalis, who is now dying of AIDS, and four other patients of a dentist, Dr. David J. Acer of Stuart, Fla., had become infected in his office.

The cluster in Acer's practice is the only known transmission of the virus from health care worker to patients among the more than 180,000 AIDS cases reported to the CDC to date. Officials have not been able to determine how the virus was transmitted.

In recent months health officials have stepped up the number of investigations of possible AIDS infection among patients of infected health care workers. The Times quotes Schwarz of the AMA as stating that 43 such look-back studies, most of them unpublished, involved 21 dentists and dental workers, 19 doctors, and 3 nurses. None of the 3,500 patients of these infected health care workers were found to be infected with the virus, Schwarz said.

Most groups at the Chicago meeting found the data strong enough to say the risk of transmission from health care worker to patient was so low that compiling lists of high-risk procedures was worthless, Schwarz explained.

At a news conference following the meeting, former Surgeon General C. Everett Koop, M.D., seemed to sum up the feeling of the medical community. "Let me assure the American public," he said, "that their chances of getting AIDS from a health care worker are essentially nil unless they are having a sexual relationship or shooting drugs and sharing needles with him or her."

In an ironic footnote, the first U.S. health care worker documented to have developed AIDS from a patient died in June. JoAnn Ruiz, RN, of Sacramento, Calif., accidentally stuck herself with contaminated blood while caring for an AIDS patient in 1987. The accident occurred after Ruiz drew blood from the patient. The patient's bed collapsed, and she accidentally injected herself with tainted blood.

After she became ill, Ruiz volunteered to provide home care for a number of patients with AIDS, including the man whose blood infected her. (1)Altman, L.K. Medical units lag on AIDS guidelines. New York Times Aug. 30, 1991.
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Author:Fitzgibbon, Robert J.
Publication:Medical Laboratory Observer
Article Type:Editorial
Date:Oct 1, 1991
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