HIV in Health Care Workers: Managing Fear through a Telephone Information Line

Abstract

In 1991, 10 years had passed since the first cases of HIV disease were announced by the Centers for Disease Control. Today, almost a decade has passed since the virus was isolated and identified. Thousands of articles have been written and multiple tries at public education have been attempted, yet health care providers still must deal with strong public reactions to HIV-related issues. On November 25, 1991, Children's Hospital of Pittsburgh announced that a nonphysician staff person working in the operating room had tested HIV positive. After learning of the technician's HIV status, the hospital conducted an exhaustive review of the records of more than 15,000 surgeries that occurred between June 1990 and November 1991 to determine in which cases the infected individual had been present in the operating room. A list of about 1,100 cases was compiled, and each case was examined for any breach of sterile procedure (for example, puncture of a glove or shedding of blood or other body fluids). No such evidence was found. Then, after consultation with the Allegheny County Health Department's Sexually Transmitted Disease/HIV Program and the Centers for Disease Control and Prevention, the medical experts agreed that the children treated in the operating room had incurred no known risk of exposure and therefore were presumably free of the virus, at least from this source. Although the risk to former patients was negligible at most, in the interest of maintaining open communications with the public, Children's Hospital released a statement to the press, noting the above information and announcing the establishment of a 24-hour telephone information line to answer the questions of parents, relatives, and hospital employees, as well as to offer literature and group education on HIV and AIDS to the general public. Although the press release stressed that there was virtually no chance that the employee could have infected any child, HIV testing for patients who had been treated at Children's Hospital during the defined risk period was offered free of charge. Although the hospital had anticipated responses at the highest level of emotion, no one predicted the magnitude or intensity- of reaction to the announcement. The telephone information line, which was staffed mainly by social workers and other hospital support staff, received more than 7,000 calls between November 25, 1991, and early January 1992, with the majority coming in during the first week after the announcement. These calls included many panicked and furious parents who wanted to know if the technician had been present in the operating room during their child's surgery. Hundreds of calls arrived during the early hours of the morning, indicating that the families perceived an immediate, major emergency. This situation contrasted sharply with a parallel occurrence that same year in a large Pittsburgh general hospital, where it was revealed that a former surgical resident had tested HIV positive. A review of the surgeon's records showed that, as at Children's Hospital, there was no breach of sterile procedure. Following this announcement, the hospital received 766 telephone inquiries over the next six months from former surgical patients and other interested parties. In this situation, the infected person had been the actual surgeon, yet only 766 people were concerned enough to call. At Children's Hospital, where the infected person was a technician in the operating room, nearly 10 times as many calls were received. Study Design Because no studies in the literature examined this type of experience with a telephone information line, we decided to investigate the emotional environment created by the disclosure that the hospital worker was HIV positive in addition to factual descriptions of the concerns, attitudes, and beliefs of the callers. We produced a questionnaire for the 57 information line workers to use to record, describe, and analyze the calls. …