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Workers and blood: call for caution.

Workers and blood: Call for caution

In the wake of the report of three newcases of health care workers infected with the AIDS virus (SN: 5/23/87, p.326), officials are stressing that health workers need to apply rigorously the recommended precautions for handling blood of all patients, and not only of those who have AIDS. This message was reinforced by a study appearing in the May 15 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (JAMA), in which researchers found that 3 percent of 203 critically ill emergency patients admitted to one hospital were infected with AIDS.

In its May 22 MORBIDITY AND MORTALITYWEEKLY REPORT (MMWR), the Centers for Disease Control (CDC) describes the circumstances of the 3 new cases:

An emergency room nurse, whosehands were chapped and who wore no gloves, applied pressure with her finger for 20 minutes to stop the bleeding of a cardiac arrest patient who was later shown to be infected with AIDS. As of four months later, 15 other employees who cared for the patient were not infected.

While collecting blood from an outpatientsuspected to be infected with AIDS, a worker was splattered in the face and mouth with blood. She was wearing gloves and eyeglasses. She had facial acne, but no open wounds. It is possible that she was infected through the mucous membrane in her mouth (although in a later incident she was scratched by a needle used to draw blood from a drug abuser whose AIDS status is unknown). A co-worker who was also splattered with blood on the face and in the mouth at the same time showed no signs of AIDS infection one year later.

Blood spilled on the unprotectedhands and forearms of a technician who was working with a machine used to separate blood components. Afterward, researchers think she may have touched inflamed skin on one of her ears. A co-worker similarly exposed at the same time did not test positive for AIDS three months after the incident.

According to James Hughes, director ofCDC's Hospital Infections Program, these cases differ from the six previously reported health-worker infections in that they did not involve any accidental needle-sticks or prolonged exposure to body fluids. Researchers suspect that the virus passed either through mucous membranes or through breaks in the skin. Hughes says this is not an unexpected transmission route, since hepatitis B viruses can infect in the same way.

The new cases, he says, do not "provideevidence that there's a greater risk [of infection] than people thought.' These kinds of exposures are very common in the health care setting, occurring many times daily all over the United States, he says, but the risk of contracting AIDS through this type of exposure, while not zero, is very small. Ongoing studies show that the risk of being infected with AIDS following a needle-stick injury is less than 1 percent, he says, and none of the nearly 400 workers put under observation after having mucous membranes or open wounds exposed to blood of AIDS patients has tested positive for the virus.

In its report, CDC restates some of itsrecommendations on the use of gloves, gowns and other protection when there is a possibility of exposure to blood or other body fluids of patients, and it adds a special caution for workers whose exposed skin is "chapped, abraded or afflicted with [inflammation].' Hughes also stresses that "we're not talking about casual transmission' and that the risk of infection through intact skin is minimal.

In their JAMA paper, James Baker andhis colleagues at the Johns Hopkins Hospital in Baltimore suggest that health care workers are complacent about taking precautions. "During the treatment of [critically ill emergency] patients, many of the basic invasive procedures continue to be performed with ungloved hands, and major resuscitations are carried out without protective measures . . .,' they write. They recommend precautions both for emergency room personnel and for paramedics, police officers and fire-fighters caring for a bleeding patient, whatever the patient's AIDS status.

CDC's Hughes adds that the JAMA andMMWR articles "should provide health care workers with a tremendous amount of motivation to follow recommended precautions and to apply those to the care of all patients.'
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Title Annotation:health care workers infected with AIDS
Author:Weisburd, Stefi
Publication:Science News
Date:May 30, 1987
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