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AIDS precautions in practice.

AIDS precautions in practice

Ample recommendations for protocols to prevent transmission of the human immunodeficiency and hepatitis B viruses have been issued and refined by major laboratory associations and Federal agencies.[1-4] Strick OSHA regs[5] seem likely to be promulgated by next year, as an article in this issue explains.

To discover how well laboratorians have digested all this information and what they are actually doing to protect themselves in the workplace, MLO recently undertook a major reader survey.

The outstanding response rate of 55 per cent (see "Survey methodology," page 32) suggests that, as expected, interest in the subject remains high. A number of respondents took the trouble of append comments and to enclose articles, manuals, work memos, and other documents.

Some chided the HIV-oriented survey for failing to discuss the more immediate danger of contracting HBV. The editors' intention in this was not to dismiss the serious problem of HBV transmission but to highlight AIDS as a specific and profound concern of the laboratory community. As one observer has written: "Managers who strive to allay practitioner concerns about the risk of AIDS by pointing to the profession's successes in safe management of virulent hepatitis B virus specimens ... may be told that `Hepatitis isn't always fatal. AIDS kills.'"[6] * How much fear? For the most part, health care workers' initial fear of receiving the virus through casual contact with AIDS patients has been allayed.[7-8] "I believe the more educated one becomes on the subject, the less fear is involved," one survey respondent said. But horror stories, some perhaps based on misinformation, persist.

Asked whether any personal experience had contributed to their feelings about AIDS protection in the lab, some respondents described incidents that were no less troubling for being hearsay. "I was told of a technician at another clinic in town who died of AIDS due to lab exposure, not life-style," said one.

"I read about nurses who had contact with body fluids on their hands and later seroconverted," said another.

A survey respondent reports that "one patient who denied he was a strong risk and refused AIDS tests (our state requires the patient's permission) proved to be homosexual and died of AIDS, finally agreeing to be tested three days before his death."

Needlesticks without evidence of seroconversion elicited concern as well. "An OR nurse stuck herself with a used IV needle from an AIDS patient," one reader recalls. "We realized more care with sharps was needed." For another respondent, a turning point was when a phlebotomist stuck herself with a needle from a patient who was known to be infected with HIV.

After reviewing the survey results, Lucia M. Berte, M.A., MT(ASCP)SBB, director of laboratory quality assurance at Elmhurst (Ill.) Memorial Hospital, found certain "misperceptions among laboratorians about the real risk of AIDS. Some reader comments suggest a level of fear and hysteria that may be out of proportion to the risk." * Reason to quit? Relatively few respondents (12 per cent) have personally considered quitting their jobs out of fear of contracting AIDS in the workplace - the rather low number partly a result, perhaps, of their overwhelmingly supervisory positions.

More than one-third (38 per cent), however, say at least one person in their laboratories has indicated an inclination to quit because of this fear. And nearly three-fourths (72 per cent) believe that such a fear has compounded the lab personnel shortage - largely, according to their comments, by discouraging people from entering it in the first place. In 18 per cent of respondents' laboratories, at least one employee has actually quit because of the fear of AIDS.

"At other institutions I had two employees leave because of AIDS," a respondent says. "One was absolutely incapacitated. She literally could not function after cutting herself with a clean glass tube. This was prior to universal precautions and prior to education about AIDS."

"We had a student a year ago who wanted to quit the program because of the fear," an educator recalls. "We did get her to stay with the program, but she has never worked in the lab."

"I know of a medical technologist in hematology," another respondent says, "who left to be trained on computers" at a large insurance company, which provided a higher-paying job. "Another tech went to ultrasound school and learned another discipline."

Hospital bed size was a factor in the desire to leave the profession. Twice as many panelists in hospitals with 200 or more beds said that someone in their labs had already quit as did those in hospitals with fewer than 200 beds (22 per cent versus 11 per cent). Those in hospitals with fewer than 200 beds, however, were more likely to have considered quitting themselves (17 per cent versus 8 per cent).

One respondent who does intend to leave the field said this: "If I got AIDS, I could infect my spouse, children, and even other members of my family. I fear AIDS and I fully plan to get out of health care before the incidence in my rural area becomes significant. Precautions are never 100 per cent. I can face death for myself, but I cannot face the fear of becoming a killer of the people I love." Sentiment this strong about leaving was rare.

As AIDS percolates to increasingly rural areas, one's geographic location seems to affect impressions and performance regarding the need for personal protection less than it did earlier. Two reader comments represent the gamut. One writes: "Our area has a very low incidence and yet we have had two AIDS patients expire and [others are] presently under treatment. The attitude previously was `AIDS - not here!'" It apparently is no longer. Says another: "This is San Francisco. We are inundated with material. There is AIDS Awareness Week! We have lost friends and coworkers to the disease."

Although fear of AIDS is probably not the major deterrent to entering the laboratory profession, "it's one of many," says Bernard E. Statland, M.D., Ph.D., medical director and head of pathology and laboratory medicine at Methodist Hospital of Indiana, Indianapolis. "We should assure students, other people interested in the field, and those considering leaving it that the necessary precautions are reasonable and we are not seeing an epidemic." * Underreporting. If comments made by many respondents are any indication, laboratorians are following the AIDS literature closely. Each announcement of a new health care worker exposure seems to arouse a new wave of concern. "Originally I thought using eyewear when operating an apheresis machine was excessive," one laboratorian says. "After reading in MMWR about the worker who seroconverted after exposure from a ruptured line, I reconsidered."

A prevailing worry is that the true numbers may in fact be far larger than those reported by the CDC and other agencies (see accompanying box, "CDC tracking job-related HIV transmission in health care workers"). The CDC, however, has never claimed to have comprehensive figures. The reporting system is voluntary; not every exposed worker is tested, notes Jacquelyn A. Polder, M.P.H., an epidemiologist with the CDC's Hospital Infections Program. Exposures in the workplace, she adds, have historically been underreported. * Universal precautions. A preponderance of respondents' laboratories (97 per cent) have adopted universal precautions (UP). UP have been in practice for six months to a year in 22 per cent of laboratories that use them, for one to two years in 46 per cent, and for more than two years in 29 per cent. UP had been instituted within the previous six months in 3 per cent of labs. Using UP, say 77 per cent of panelists, is the single most effective measure to prevent their own exposure to HIV.

Almost all respondents' labs (94 per cent) provide UP instruction as part of the lab's orientation program. Follow-up, however, is less pervasive. Just under half (46 per cent) test new employees to determine whether they fully comprehend what they have been taught - most by observing the person's work for a specified period (60 per cent of those that test). Others are accountable by interview (30 per cent) or written test (24 per cent).

Refresher courses are given at least once a year for the entire lab staff in 75 per cent of labs. Somewhat more (85 per cent) provide in-service programs regarding protection against HIV exposure. In hospitals with 200 or more beds, the latter figures rises to 93 per cent. Hospital labs are more likely to provide annual instruction on UP than independent or group practice labs (80 per cent versus 58 per cent, respectively).

Refresher courses are provided in these forms (answers overlap): continuing education programs, 68 per cent; written procedure with sign-off, 38 per cent; video viewed at designated times, 36 per cent; video viewed at employee's discretion, 15 per cent; written procedure without sign-off, 7 per cent; individual assigned to observe workers, 4 per cent; and other, 5 per cent.

For longtime employees, the situation becomes more muddled. More than one-third of labs (38 per cent) have no system of checks and balances to make sure employees are following lab policy regarding precautions against the transmission of infection. More often than not - but far from universally - adhering to these policies is part of job performance standards (70 per cent) and of employee performance appraisals (62 per cent).

Among the 34 per cent of laboratories where employees have balked at following policies regarding precautions against HIV exposure, resistance consisted of ignoring the policy when no one was thought to be watching (66 per cent), halfhearted efforts overall (54 per cent), outright refusal (15 per cent), and other means (6 per cent).

The content of policies concerning precautions against HIV exposure is determined by laboratory management in 61 per cent of respondents' labs, by the safety/ security committee in 49 per cent, by the institution's AIDS task force in 12 per cent, by the infection control department in 8 per cent, by the hospital administration or laboratory owner in 7 per cent, and by other authorities in 6 per cent.

Generally speaking, laboratorians in independent or group practice labs and large hospitals tend to report better protection and adherence to UP than smaller hospitals. Urban locations and states with relatively larger AIDS populations also seem to have stricter controls.

Personal experience is often thee clincher in convincing laboratorians of the need for specific kinds of protection. "I have had blood sprayed in my eyes and face," writes one respondent, who concluded that the lab needs face masks with eye guards.

Nearly all survey respondents (92 per cent) said that, in general, their labs provided sufficient protective gear and devices - a figure in line with a recent OSHA survey that found 90 per cent of hospitals and medical/dental labs complied with its proposed personal protection equipment standards.(9) But when they came to the next group of survey questions, asking which devices their institutions provided in insufficient supply, more than half (55 per cent) checked one or more of the devices listed (see Table I for an inventory). Reasons given by employers for failing to provide sufficient supplies are listed in Table II.

Personal protection devices

Table : Table 1 Which of the following personal protection devices, if any, do you believe are NOT sufficiently supplied by your laboratory?
Lab coats 56%
Biohazard hoods 36
Impermeable aprons 28
Long, heavy-duty gowns 26
Gloves in appropriate sizes 25
Face shields or goggles 22
Eyewash basins 22
Specimen containers 12
Rigid containers for sharps 12

Total exceeds 100 per cent to multiple responses. Percentages are of the 55 per cent of respondents who felt supplies of at least one type of device listed were insufficient.

Table : Table II Has your employer ever given reasons for failing to provide sufficient supplies of protective devices? If so, what were they?
Gave no reason: Gave reason:
 55% 45%
Too expensive 52%
Couldn't obtain 35

OSHA guidelines aren't
 regulations yet 15
Unnecessary 11
Other reasons 15

Total exceeds 100 per cent due to multiple responses. Figures represent percentages of the 45 pe cent of respondents who believe supplies are inadequate at their institutions.

As hospital bed size increased, so did the likelihood of considering protective devices to be adequately supplied (under 200 beds, 41 per cent; 200 to 299 beds, 45 per cent; 400 or more beds, 53 per cent). Laboratorians in states with high concentrations of AIDS patients - for the purpose of this study, California, Florida, and New York, although the numbers in New Jersey, Texas, and elsewhere are rising - reported sufficient supplies more often than those in all other states (70 per cent versus 61 per cent). Throughout the survey, in fact, respondents in larger cities, in larger institutions, and in states with a high prevalence of high-risk patients were most likely to feel they had enough supplies, instruction, and protocols.

For the most part, respondents believe their labs are making sufficient efforts to protect workers against infectious diseases (78 per cent). Of the remainder, 16 per cent say their labs are not doing enough and 6 per cent consider their labs' efforts excessive.

Slightly more sanguine are feelings about whether labs are making enough of an effort to educate workers about their risk of acquiring HIV/AIDS in the workplace. According to 81 per cent, efforts are sufficient. Labs are not doing enough in 16 per cent of cases and too much in 3 per cent, panelists believe.

Regarding the relatively high degree of confidence respondents expressed in their labs' efforts, it's again important to remember that most panelists are at the supervisory level or above. * What's worn when. Respondents were asked how often they put on and changed lab coats (Table III). Overall, they were least likely to remove their lab coats when leaving the lab for the bathroom.

Table : Table III Do you routinely remove your lab coat before going:
Home? 96%
To the cafeteria? 59

To an area of the facility

outside the lab? 47

To the gift shop or

other area where sundries
 are sold? 45
To the employee lounge? 36
To the bathroom? 26

Total exceeds 100% due to multiple responses.

Panelists were also asked which personal protection devices were routinely worn by workers at their labs while performing specific activities (Table IV). Responses indicate that single gloving is extremely common, while double gloving is rare. Gowns are worn approximately one-fourth of the time. Biological safety cabinets are seldom used except for mycobacteriology studies (55 per cent of the time) and respiratory cultures (33 per cent). [Tabular Data Omitted]

The figures for safety cabinet use are alarmingly low, says Gerald A. Hoeltge, M.D., chairman of the department of blood banking at the Cleveland Clinic Foundation. Among other reasons, "Tubercle bacilli pose a real hazard" in the lab, he observes. Nor is lack of availability the likely problem: "I have been in lots of laboratories where cabinets were available but not used," he notes, because they were considered inconvenient.

When readers were asked how often, if ever, workers at their lab used masks and/or eyewear when removing caps from collection tubes containing patient blood, 10 per cent said always, 9 per cent said usually, 17 per cent said sometimes, 31 per cent said rarely, and 35 per cent said never. Of those saying "never," few use a biological safety hood for the same purpose; most (79 per cent) said this is never done.

A large number of respondents complained that wearing gloves makes laboratory workers feel clumsy and increases mishaps. A typical comment: "The number of accidents caused by wearing gloves in our environment (patient redraws, dropped tubes) and the dermatitis being experienced make me sure we are creating `overkill' [in protective measures] and causing an erroneous gloom and doom attitude to pervade our profession."

Said another, "A pair of gloves caused me to have greater exposure to a known AIDS specimen than I would have had without them. A phlebotomist in another section received a needlestick as a result of wearing gloves."

Representing many others' feelings, one respondent writes, "I think the emphasis on gloving can lead to a false sense of security." Says yet another, "I think the use of gloves in the lab and phlebotomy should be enforced only when there is a chance of contact with body fluids or if the skin is broken in any way. Gloves can cause the skin to break out in an allergy, and they also can be cumbersome."

Laboratorians' degree of comfort with gloves and other gear depends largely on whether they wore those protective devices while being trained in the first place, notes Diana L. Headley, M.A., MT(ASCP)SC, coordinator for continuing education and outreach at the clinical laboratories of the University of Nebraska Medical Center, Omaha. How the new information is presented is very important, she adds; scare tactics are to be avoided. The right tack, Headley says, is to make it clear to lab workers that learning the correct procedures is to their advantage.

Peter C. Fuchs, M.D., Ph.D., director of microbiology at St. Vincent Hospital and Medical Center in Portland, Ore., points out that there is a learning curve as phlebotomists who are used to working without gloves grow accustomed to wearing them - probably, he feels, entailing a period of greater risk of needlesticks.

"No one has ever demonstrated the benefit of wearing gloves for phlebotomy," he says. "There is not a shred of data to support it - it's all theoretical." Dr. Fuchs urges institutions with good accident reporting systems to consider performing and publishing studies of needlestick incidents before and after mandating glove use for phlebotomists. Demonstrating fewer incidents or even no change in their number, he suggests, would make it more worthwhile to embrace the theory that gloves help prevent accidents.

Changing gloves and washing hands after processing specimens is done with considerable frequency: 43 per cent said this is always done at their labs, 40 per cent said "usually," and 14 per cent said "sometimes." Hand washing habits in general are revealed in Table V. [Tabular Data Omitted] * Changing practices. The vast majority of respondents' labs (90 per cent) no longer permit mouth pipetting under any circumstances. Dr. Hoeltge wonders how to reconcile the 10 per cent who continue the practice - in rural areas, 19 per cent - with the 97 per cent who report using universal precautions. One respondent said mouth pipetting is done only with distilled water. Nevertheless, Dr. Hoeltge insists, pipetting aids should be used "across the board, even with substances wholesome enough to ingest," because you never know when a mistake may be made.

Recapping needles in disposable syringes has been discontinued in 72 per cent of labs. It is still done "under certain circumstances" in 12 per cent and "under stricter requirements than before AIDS became an issue" in 16 per cent.

The questionnaire asked whether respondents' labs had policies regarding the removal of gloves before certain objects in the laboratory could be touched. Most did. Before using typewriter and computer keyboards, telephones, and photocopiers, workers in about three-fourths of respondents' labs are expected to remove gloves. Before touching doorknobs, 54 per cent must do so.

Regardless of whether the lab has such a policy, the survey asked, does its staff routinely remove gloves before touching those objects? Compliance was uniformly low. Only 17 per cent said all workers in their labs did so; 28 per cent said at least three-fourths did; 14 per cent pointed to less than three-fourths; and 24 per cent said "hardly any or none." Another 18 per cent were unsure.

Perhaps poor compliance is a function of questioning the value of the practice. One respondent, echoing the sentiments of others, says, "I have seen enough people in the lab wearing contaminated gloves touch normal items (computers, phones, etc.) that if I should ever decide to wear gloves, it would be to protect myself from the contamination they have caused."

Other readers expressed concern that persons wearing gloves are less likely to notice serum or other substances on their hands and are thus more likely to transmit them accidentally. One respondent recalled having seen a lab worker eating lunch with gloves on because she had forgotten to take them off.

Commonly touched objects are routinely cleaned after being touched by gloved hands in 24 per cent of respondents' labs. Keyboards and such are not cleaned in 45 per cent. Another 31 per cent of readers were unsure. The response suggests that many laboratorians are unaware of their labs' positions on the issue. This impression is borne out by a number of reader comments suggesting that many labs have no clear policy in this regard. * Identifying patients. A continuing source of dissension among laboratorians is whether specimens from patients known to have AIDS, hepatitis, or other infectious diseases should be labeled as such. Patient confidentiality is not necessarily the reason for forgoing labels; universal precautions, many believe, make labeling redundant. A frequently heard contention is that using biohazard labels for known contaminated specimens may actually increase the overall risk of infection by giving workers a false sense of security when handling unidentified contaminated specimens.(10,11)

Equally adamant is the opposing faction. The tremendous number of panelist comments on the right to know patients' HIV status indicates many would agree with the pathologist who wrote: "Just as the hairpin curves and blind intersections of highways are marked with warning signs although though accidents can also occur on the straight, so should the clinical laboratory staff be alerted whenever dangerous specimens are known to be present."[12]

Laurence I. Alpert, M.D., director of laboratories at Northern Westchester Hospital Center in Mount Kisco, N.Y., notes with interest that nearly half (49 per cent) of respondents' institutions identify specimens from patients known to be positive for HIV antibodies even though 97 per cent subsribe to universal precautions. "I think we will see this figure of 49 per cent fall considerably in the next year," he says, "as lab personnel become accustomed to universal precautions techniques.

"In my institution," Dr. Alpert continues, "we have compromised strict universal precautions only in regard to tissues coming from the operating room. Those specimens of patients known to be either HIV or HBV positive - because of information on the circulating nurses' review of the patient's chart - are labeled `Blood and Body Fluid Precautions' before being sent to the histology laboratory."

In labs that identify specimens known to contain HIV, 55 per cent use general labels with such messages as "Infectious Material"; 39 per cent use color-coded labels; 8 per cent use nondescriptive abbreviations to preserve patient confidentiality; and 7 per cent use color-coded bags. Other methods are used in 6 per cent of panelists' laboratories.

Before patient specimens are transported, they are bagged in 60 per cent of respondents' labs; double-bagged in 10 per cent; placed in a puncture-proof container in 11 per cent; and parafilmed in 5 per cent. None of those methods are used in 20 per cent of labs. Other methods are used in 5 per cent. (The total exceeds 100 per cent due to multiple responses.)

Several respondents pointed out that most HIV-positive patients are not identifiable as such, unlike hepatitis patients, who may look jaundiced or have other telltale symptoms. "After working for years with private-practice physicians and feeling I knew the patients well enough to know if I were at risk," a panelist writes, "I discovered that HIV-positive patients had been seen in our clinic without my knowing it."

Identifying patients can have unusual repercussions. One respondent reports an incident in which a nurse learned that a relative was HIV positive by reading the chart before prepping the patient for surgery: "The relative got very upset afterward. It shows you can't be too careful."

The double bind of confidentiality versus the worker's right to know seems unlikely to be resolved in the immediate future. Typifying the disagreement is a report on the impact of AIDS issued in January by the Hospital Association of New York State. It identifies labeling of infectious specimens as a key staffing issue: "Problems concerning recruitment of new [health care] staff and retention of existing staff will not be completely resolved until concerns about HIV infection are addressed and the proper balance between patient rights and worker rights is achieved."[13] Yet the state's AIDS Advisory Council voted on March 1 against requiring AIDS testing of patients of unknown HIV status after an accidental needlestick by a health care worker with a syringe containing that patient's blood.[14] * Spills, injuries, waste. Protocols used for injuries are listed in Table V1. A look at drug prophylaxis ("Management after exposure") appears on the same page. [Tabular Data Omitted]

A panelist writes: "We found that the large opening of our sharps container is dangerous. There was one incident where a tray was dropped and a dirty needle flew out and struck a phlebotomist. We have since cut the top in half and closed the larger opening." Another says: "I had an experience where a contaminated needle flipped up when being unscrewed into a sharps container. This reinforced the need to use caution even when the proper equipment is available.

Respondents' procedures for spills and disposal of waste products are listed in Tables VII and VIII. It is disappointing that only 79 per cent segregate infectious wastes, notes Dr. Hoeltge: "It's good practice to channel wastes into the appropriate waste streams," he says. "Putting everything into one big container is inefficient at best, and could be harmful." Dr. Hoeltge was also surprised that so many respondents (11 per cent) do not know how their labs' wastes are disposed of.

Table : Table VII Spills

Does your lab have a protocol for cleaning up spills of known/potentially contaminated materials?

Yes 94%/94% No 6%/6%

At your lab, what disinfectant(s), if any, are used to clean up spills of contaminated or potentially contaminated materials?

Bleach 93%

Commercially manufactured
spill cleanup kits 43
Phenols 25
Alcohol 19
Quaternary compounds 11
Ammonia 3
Formalin 3

Dilutions of bleach in water consisted most often of 1:10 (41%) and 1:9 (23%). Equal strength (1:1) was cited by 14% of respondents. Another 20% gave a range of five to 10 parts water; 16% said one to 10 parts water were used.

Table : Table VIII Waste disposal practices

Where does your lab keep puncture-proof biohazard containers for disposal of sharps?
In the laboratory 94%
On phlebotomy carts 78
In every patient room 57
In the emergency room 57
In ward rooms 25
Do not use 1

In your lab, are containers for infectious nonsharps:

Color-coded 65%

Not color-coded, but
 handled separately 17
Neither 18

What, if anything, does your lab segregate from other waste?
Infectious waste (laboratory) 79%
Glassware 59

Biohazardous (radioactive)
 material 51
Paper 39

Medical waste (operating room,
 patient room) 27
Nothing (do not segregate waste) 7

What, if anything, does your lab segregate from other laundry? Nothing (do not segregate laundry) 72%
Contaminated lab coats 20
Contaminated gowns 17

Uncontaminated or potentially contaminated lab coats 10

Uncontaminated or potentially contaminated gowns 7

In your lab, who pays for laundering of lab coats?
Employee 56%
Institution 44

Many respondents expressed the wish that their employers would provide and wash lab coats.

In your lab, is glassware disposed of in rigid containers?

Yes 80% No 20%

If yes, how are these rigid containers disposed of?
Incineration 62%
Steam sterilization 18

Inactivation of etiologic agents

before disposal in landfill or
 sanitary sewer 8
Contracted service 4
Other 6
Don't know 11

If no, what, if anything, is being done to prevent accidental cuts from broken glass after disposal?
Nothing 43%
Glassware is mixed with sharps 19
Glassware is separated 8
Double bagging 8

Housekeepers wear impermeable/
 metal mesh gloves 5
Housekeepers wear rubber gloves 2
Other 19

Some totals exceed 100% due to multiple responses. * Positive response. Results of the MLO survey suggest that although follow-up and compliance could be improved - in some cases, considerably - the laboratory community has for the most part reacted swiftly and attentively to help workers protect themselves from direct exposure to HIV. If measures are sometimes seen as extreme and expensive in a time of ever-tightening budgets, they may nevertheless serve to protect laboratorians from other infectious diseases more scrupulously than ever before. As one panelist writes: "If there is anything positive about AIDS as it relates to the lab, it may be that it has forced us to take a hard look at our practices in infection control. Laboratorians, whether they wear gloves or not, are now more aware of the need to exercise extreme caution when handling biological material."

Dr. Statland considers the clinical laboratory community's progress in this connection to be remarkable. "Within a few years," he observes, "we have gone from hysteria and indifference to a sensible middle ground in which universal precautions have become an accepted mode of practice. It represents a real success story - a victory."

Yet there is clearly more work to be done. Despite the 97 per cent use of universal precautions, notes Dr. Hoeltge, 15 per cent of labs do not provide in-service programs on the subject and 6 per cent do not train new employees about it. Clearing up some loose ends may be in order at many laboratories.

The laboratorians who participated in the survey, Dr. Hoeltge says, probably understand the issues very well. Their reporting a somewhat low level of compliance "indicates that they are being very honest and forthright."

The letter guaranteeing anonymity that was attached to the MLO questionnaire may have contributed to the candid nature of responses. On reflection, for example, a panelist who has worked in the clinical laboratory field for 25 years admits, "I probably teach our new MLT students better precautions than I practice." * Long view. Experienced laboratorians seem most likely to take the challenge of occupational risk in stride. "AIDS has, in my estimation, been blown out of proportion," one says. "Many of us lived through the polio era, the diphtheria era, and many others. We did this by adhering to good laboratory practice, not by separating specimens for special handling."

"We in our laboratory," another writes, "are an `older' group of certified MTs who have been at this institution for five to 16 years. We feel that with caution and care, we all have avoided hepatitis through the years, and we can protect ourselves now with the same practices in addition to the gloves, gowns, goggles, masks, and benchtop hoods provided by our employer.

"Ten years down the road," this respondent continues, "I imagine that folks in the profession will be saying, `You did what?' to our `war stories' of the AIDS scare of the '80s and '90s. I recall the quarantine regimen for tuberculosis and scarlet fever and compare that to today's treatment of AIDS patients. In my opinion we should quell the hysteria and let sanity and common sense reign."

"There is always a risk in the laboratory," another longtime laboratorian points out, "and there always has been. It's unfortunate that a disease such as AIDS had to surface to make medical facilities conscious of the possible dangers in handling blood, body fluids, and tissue. We should have been policing ourselves and taking proper precautions decades ago. Better late than never."

1. National Committee for Clinical Laboratory Standards. Protection of laboratory workers from infectious disease transmitted by blood, body fluids, and tissue; tentative guideline. NCCLS Document M29-T. Villanova, Pa., NCCLS, 1989.

2. Centers for Disease Control. Protection against viral hepatitis. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 39(RR-2), Feb. 9, 1990.

3. Centers for Disease Control. Occupationally acquired human immunodeficiency virus infections in laboratories producing virus concentrates in large quantities: Conclusions and recommendations of an expert team convened by the Director of the National Institutes of Health (NIH). MMWR 37(S-4): 19-22, April 1, 1988.

4. Committee on Hazardous Biological Substances in the Laboratory, National Research Council. "Biosafety in the Laboratory: Prudent Practices for the Handling and Disposal of Infectious Materials." Washington, D.C., National Academy Press, 1989.

5. Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; proposed rule and notice of hearing. Federal Register, pp. 23041-23139, May 30, 1989.

6. Oliver, J.S. Clinical laboratory professionals caught in the crossfire between politics and safety: The AIDS epidemic and its implications for these publicly invisible scientists. Am. Med. Writers Assn. J. 2(4): 9-12, September 1987.

7. Gottfried, E.L. Acquired immunodeficiency syndrome and the clinical laboratory worker. Arch. Pathol. Lab. Med. 111: 1024-1026, 1987.

8. Soloway, H.B. The risk of AIDS infection from casual job contact. MLO 19(9): 33-36, September 1987.

9. Naber, T. New OSHA regs cost $852 million (News Front). Diagnostics & Clin. Testing 27(5): 14, July 1989.

10. Gottfried, E.L. Response to: Godfrey, S.E. Acquired immunodeficiency syndrome and the clinical laboratory worker (Letter). Arch. Pathol. Lab. Med. 112: 482, 1988.

11. Handsfield, H.H.; Cummings, M.J.; and Swenson, P.D. Prevalence of antibody to human immunodeficiency virus and hepatitis B surface antigen in blood samples submitted to a hospital laboratory. JAMA 258: 3395-3397, 1987.

12. Godfrey, S.E. The labeling of specimens as infectious (Letter). JAMA 259: 1807, 1988.

13. Hospital Association of New York State. "The Impact of AIDS in New York State," p. 25. Albany, N.Y., Jan. 15, 1990.

14. AIDS panel agrees on sex counseling of Catholic patients. New York Times, p. B4, March 2, 1990.
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Title Annotation:includes related articles
Author:Barman, Marcia Ringel
Publication:Medical Laboratory Observer
Date:Apr 1, 1990
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