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AIDS watch: data on exposed health workers.

DO A Centers for Disease Control surveillance team, which has followed 1,201 health care workers exposed to blood from patients infected with human immunodeficiency virus, concluded recently that 37 per cent of the exposures might have been prevented if the workers had taken recommended infection control precautions.

Even so, the risk of HIV infection after such exposure was deemed low. As of July 31, 1988, 963 of the health care workers had completed at least 180 days of follow-up after exposure. I were tested for HIV antibody at that stage; 752 were also tested at 12 months or longer, and 248 at 24 months or longer. Only four workers had serum specimens positive for HIV antibody.

These findings were reported in an Oct. 27 New England Journal of Medicine article' by Ruthanne Marcus, M.P.H., and the CDC Cooperative Needlestick Surveillance Group, which consists of 10 CDC investigators and cooperating investigators from 335 medical institutions nationwide. Marcus is with the CDC's Hospital Infections Program.

Also enrolled in the surveillance project, but excluded from analysis in the article, were 106 workers exposed to body fluids other than blood. None of these seroconverted.

Some of the data in the Marcus article were based on the 1,201 health care workers with blood exposures, not only the 963 who were tested six months or longer after exposure. Of the larger group, 80 per cent were exposed to blood of an HIV-infected patient by a needlestick, 8 per cent by a cut with a sharp object, 7 per cent by contamination of an open wound, and 5 per cent by contamination of mucous membrane.

All four of the workers who seroconverted were needlestick victims. One case was reported previously. The others involved a worker who received a deep intramuscular needlestick from a large-bore needle, inflicted by a co-worker during a resuscitation procedure on an AIDS patient; a worker who, similarly, received a deep needlestick injury from a 21 gauge needle held by a co-worker during a resuscitation attempt on an AIDS patient; and a worker who received two needlestick injuries 10 days apart-the first while recapping a needle that had been used on a patient with AIDS, the second after drawing blood from a patient with symptomatic HIV infection.

Fourteen reports of seroconversion in health care workers have been published in addition to the three set down in detail in the Marcus article. Nine of the seroconversions occurred after injuries with needles or sharp instruments, and four after other forms of blood exposure. One case, outside the health care setting, involved a mother who provided extensive nursing care to her HIVpositive infant and often had blood and secretions on her ungloved hands.

Of the 1,201 workers with blood exposures, 63 per cent were nurses, 14 per cent physicians or medical students, 11 per cent laboratorians, 7 per cent phlebotomists, 3 percent respiratory therapists , and 2 per cent housekeeping or maintenance workers. By site, 65 per cent of the exposures occurred in a patient's room, on a ward, or in an outpatient clinic; 14 per cent in an ICU; 7 per cent in an operating room; 7 per cent in a laboratory; 5 per cent in an emergency room; and 2 per cent in a morgue.

Finally, here's a breakdown of the 37 per cent of exposures that might have been prevented had health care workers used recommended precautions: recapping used needles by hand, 17 per cent; improper disposal of used needles or sharp objects, 14 per cent; and contamination of an open wound, 6 per cent. The remaining 63 per cent of exposures occurred during manipulation of an intravenous, phlebotomy, or arterial needle (36 per cent); during the performance of an invasive procedure (8 per cent); during autopsy (2 per cent); or during various other procedures (17 per cent).
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Author:Fitzgibbon, Robert J.
Publication:Medical Laboratory Observer
Article Type:editorial
Date:Dec 1, 1988
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