Human immunodeficiency virus infection and hepatitis: biosafety in radiology.

Abstract

Radiologists frequently perform invasive diagnostic and therapeutic procedures involving needles and/or vascular access, and often they do so in darkened rooms. Therefore, they are at risk of exposure to blood-borne pathogens. The risk of HIV infection with a single sharp injury is low (0.3%), and on average 99.7% of exposures will not result in infection. However, this seroconversion rate is increased when a high volume of blood or a high concentration of virus is inoculated, and it is decreased by 79% when postexposure prophylaxis is used. An estimated 800,000 needle-stick injuries and other injuries from sharp objects to health care workers occur annually in the United States (25). Approximately 16,000 of these involve HIV-contaminated blood, and even more are contaminated with HBV or HCV (46). Needle-stick injury therefore poses the single greatest risk to health care workers regarding occupational transmission of HIV. Because most patients in the radiology department have an unknown HIV or hepatitis serostatus, all patients should be regarded as potentially infectious, and precautions should be universal. In fact, the 1991 OSHA ruling made compliance with the CDC Universal Precautions Guidelines the enforceable national standard. Real-time oral communication among all members of the radiology team and scrupulous attention to safe technique are absolutely essential. Radiologists are not in agreement regarding the use of precautions against injury with a sharp object and splashing (47-50). Many have adapted some of their habits to conform well to the CDC and OSHA guidelines regarding universal precautions, but some remain skeptical regarding the risk of exposure to themselves. Consequently, in some areas resistance to the above recommendations persists. However, the data to date provide a compelling argument for protection against occupational exposure to blood either by percutaneous sharp injury or splashing on mucous membranes or interrupted skin. A number of resources were made available in early 1997 for easy access to the most current data regarding occupational transmission of HIV or hepatitis. For instance, the CDC has a World Wide Web site (http://www.cdc.gov) and a facsimile information service through the Hospital Infections Program directory (telephone 404-332-4565). Also, the National AIDS Clearinghouse can be reached by telephone (800-458-5231), as can the HIV/AIDS Treatment Information Service (800-448-0440). The postexposure prophylaxis protocol used at the University of California, San Francisco, can be reviewed by visiting its World Wide Web site at http://epi-center.ucsf.edu. And up-to-date information is available to both Veterans Administration and other health care staff worldwide by J. Michael Howe, MSLS, of the AIDS Information Center, a service of the VA HIV/AIDS National Training Program, located at the Veterans Administration Medical Center, San Francisco, University of California, San Francisco (hivinfo@itsa.ucsf.edu).