Transmission of HIV to Health Care Workers

The percentage of health care workers with AIDS who have “no identified risk” for HIV infection has remained low (< 10%) and has not increased over time, despite the dramatic increase in the number of AIDS cases and concomitant exposure of health care workers to patients with HIV disease. More importantly, detailed studies examining the risk of specific exposures, such as needle stick injuries and mucous membrane exposures, have demonstrated very low risk of disease acquisition in the workplace. More than 3628 health care workers have been examined prospectively in carefully designed surveillance studies at 10 high-incidence medical centers.

The overall risk of seroconversion after a percutaneous needle stick from a known HIV-positive source is 0.25% per exposure. Although mucous membrane exposures to HIV-positive blood have resulted in seroconversion in at least three health care workers, prospective studies of over 900 splash exposures have failed to identify any seroconverters, implying that the risk of infection is even lower after mucous membrane exposure than through percutaneous needle stick.

To date, no transmission has occurred after exposure to body fluids other than blood or fluids heavily contaminated with blood. Therefore, although the potential for HIV transmission to health care providers clearly exists, the risk of infection is inherently low and can be further minimized by following routine precautions to prevent transmission.

Despite their logical basis and relative ease of implementation, universal precautions have not been used routinely by many health care providers. Recent studies have shown that > 50% of health care workers engage in inadequate infection control practices, even in high-impact AIDS centers, and up to 40% of the needle stick exposures were judged to be preventable. Although lack of adequate education may partly explain these findings, implementation of infection control practices has been generally poor historically. Between 200 and 400 health care workers die each year as a result of hepatitis B infection acquired on the job. The use of universal precautions helps minimize the transmission of many transmissible diseases in addition to HIV.

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